FORM 1023-EZ for NORTHERN LIGHTS ARCHERY CLUB

Field Data
EIN 27-4257335
Case Number EO-2015058-000253
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHERN LIGHTS ARCHERY CLUB
Organization’s Mailing Address 114 3RD STREET SW SUITE D
City ROSEAU
State MN
ZIP 56751
Accounting period End 12
Primary contact name MARK WILSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT MOSER
PRESIDENT
102 4TH STREET SW
ROSEAU MN 56751

Officer/Director/Trustee Two

MATTHEW PRUSAK
VICE-PRESIDENT
49769 340TH STREET
SALOL MN 56756

Officer/Director/Trustee Three

PATRICK MONKMAN
TREASURER
36045 COUNTY ROAD 13
SALOL MN 56756

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/28/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N30 - Physical Fitness and Community Recreational Facilities
Organization’s purpose Charitable: Yes
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 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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