FORM 1023-EZ for CITY OF CLEARLAKE ANIMAL ASSOCIATION

Field Data
EIN 83-0860030
Case Number EO-2018344-000167
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CITY OF CLEARLAKE ANIMAL ASSOCIATION
Organization’s Mailing Address 9348 YAQUIMA DR
City KELSEYVILLE
State CA
ZIP 95451
Accounting period End 12
Primary contact name JOHN MORETZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN MORETZ
CHIEF EXECUTIVE OFFICER
9348 YAQUIMA DR
KELSEYVILLE CA 95451

Officer/Director/Trustee Two

CHARMAINE WELDON
CHIEF FINANCIAL OFFICER
17236 CEDAR WAY
CLEARLAKE OAKS CA 95423

Officer/Director/Trustee Three

WILLOW GOLDTOOTH
SECRETARY
PO BOX 1371
MIDDLETOWN CA 95461

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/26/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 JOHN MORETZ
Signature Title CHIEF EXECUTIVE OFFICER
Signature Date 12/6/18

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