FORM 1023-EZ for MID VALLEY YOUTH LACROSSE

Field Data
EIN 81-3963971
Case Number EO-2021174-000359
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MID VALLEY YOUTH LACROSSE
Organization’s Mailing Address 1260 NW 21ST STREET
City ALBANY
State OR
ZIP 97321
Accounting period End 12
Primary contact name DUSTIN SCOTT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DUSTIN SCOTT
PRESIDENT
1260 NW 21ST STREET
ALBANY OR 97321

Officer/Director/Trustee Two

JEREMY STILL
VICE PRESIDENT
32123 TANGENT DRIVE
TANGENT OR 97389

Officer/Director/Trustee Three

ANDREA STILL
TREASURER
32123 TANGENT DRIVE
TANGENT OR 97389

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DUSTIN SCOTT
Signature Title PRESIDENT
Signature Date 6/21/2021
EIN 81-3963971
Case Number EO-2016272-000378
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MID VALLEY YOUTH LACROSSE
Organization’s Mailing Address 3590 NW SCENIC DR
City ALBANY
State OR
ZIP 97321
Accounting period End 12
Primary contact name SHANE LYON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHANE LYON
OFFICER
3590 NW SCENIC DR
ALBANY OR 97321

Organization’s website HTTPS://LEAGUES.BLUESOMBRERO.COM/DEFAULT.ASPX?TABID=1148418
Organization’s email MVYLAXSHANE@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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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