FORM 1023-EZ for LAKE PARK CHILDREN AND COMMUNITY SERVICE CLUB

Field Data
EIN 82-2702558
Case Number EO-2017251-000468
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE PARK CHILDREN AND COMMUNITY SERVICE CLUB
Organization’s Mailing Address 205 N MARKET ST
City LAKE PARK
State IA
ZIP 51347-0247
Accounting period End 12
Primary contact name CARRIE JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARRIE JONES
PRESIDENT
205 N MARKET ST
LAKE PARK IA 51347

Officer/Director/Trustee Two

MELVIN ZEVENBERGEN
VICE PRESIDENT
127 MARKET ST
LAKE PARK IA 51347

Officer/Director/Trustee Three

PATRICIA FORBES
SECRETARY TREASURER
274 COUNTRY CLUB DR
LAKE PARK IA 51347

Officer/Director/Trustee Four

DOUGLAS GOODELL
MEMBER
1487 135TH AVE
LAKE PARK IA 51347

Officer/Director/Trustee Five

MARIE MATTHIESEN
MEMBER
217 MARKET ST
LAKE PARK IA 51347

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/2017
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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