FORM 1023-EZ for LEWISTOWN SOCCER CLUB

Field Data
EIN 82-3960198
Case Number EO-2018016-000245
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEWISTOWN SOCCER CLUB
Organization’s Mailing Address PO BOX 451
City LEWISTOWN
State MT
ZIP 59457
Accounting period End 12
Primary contact name DIANN DEROSIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAURA FLUGGE
PRESIDENT
124 CARROL TRAIL
LEWISTOWN MT 59457

Officer/Director/Trustee Two

DIANN DEROSIER
TREASURER/SECRETARY
227 SNOWY MOUNTAIN DR
LEWISTOWN MT 59457

Officer/Director/Trustee Three

JOE BOYLES
VICE PRESIDENT
PO BOX 1043
LEWISTOWN MT 59457

Officer/Director/Trustee Four

JEFF FRIESEN
BOARD MEMBER
415 BOULEVARD
LEWISTOWN MT 59457

Officer/Director/Trustee Five

BRETT THACKERAY
BOARD MEMBER
211 SKYVIEW
LEWISTOWN MT 59457

Organization’s website
Organization’s email LEWISTOWNSOCCERCLUB1@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/17
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
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 Yes
Correctness Declaration Yes
Signature Name DIANN DEROSIER
Signature Title TREASURER/SECRETARY
Signature Date 1/10/18

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