FORM 1023-EZ for ALKI ROAD MENTORING

Field Data
EIN 82-4741072
Case Number EO-2018106-000877
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ALKI ROAD MENTORING
Organization’s Mailing Address 2183 N 3RD ST
City WASHOUGAL
State WA
ZIP 98671
Accounting period End 12
Primary contact name PATRICIA JOHNON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN GRIFFIN
PRESIDENT
2183 N 3RD
WASHOUGAL WA 98671

Officer/Director/Trustee Two

LACEY GRIFFITHS
VICE PRESIDENT
2183 N 3RD
WASHOUGAL WA 98671

Officer/Director/Trustee Three

STACY RERICK
SECT-TREASURER
2183 N 3RD
WASHOUGAL WA 98671

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/29/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 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 GRIFFIN
Signature Title PRESIDENT
Signature Date 4/3/18

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