FORM 1023-EZ for BAREFOOT DANCE CLUB

Field Data
EIN 85-3519471
Case Number EO-2020296-000770
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BAREFOOT DANCE CLUB
Organization’s Mailing Address 12430 SW ASH AVE APT 1
City TIGARD
State OR
ZIP 97223
Accounting period End 12
Primary contact name ROBERT EVANS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT EVANS
PRESIDENT
12430 SW ASH AVE APT 1
TIGARD OR 97223

Officer/Director/Trustee Two

ELANGO SAMY MANIM
TREASURER
685 NW AUTUMNCREEK WAY APT 1209
BEAVERTON OR 97006

Officer/Director/Trustee Three

LYNN DARGENT
SECRETARY
9225 SE CORA STREET
PORTLAND OR 97226

Officer/Director/Trustee Four

MARJORIE TAYLOR
VICE PRESIDENT
10322 NE EVEERGREEN PARKWAY APT 10
HILLSBORO OR 97124

Organization’s website WWW.BAREFOOTDANCECLUB.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A62 - Dance
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROBERT EVANS
Signature Title PRESIDENT
Signature Date 10/19/2020

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