FORM 1023-EZ for FOREST GROVE YOUTH BASKETBALL ORGANIZTION

Field Data
EIN 13-4360291
Case Number EO-2015127-000466
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FOREST GROVE YOUTH BASKETBALL ORGANIZTION
Organization’s Mailing Address 1401 NICHOLS LANE
City FOREST GROVE
State OR
ZIP 97116
Accounting period End 6
Primary contact name KEITH GODFREY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAN LUMPKIN
PRESIDENT
2131 BABBIT CT
FOREST GROVE OR 97116

Officer/Director/Trustee Two

KEITH GODFREY
TREASURER
2326 GARDENIA ST
FOREST GROVE OR 97116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/5/2007
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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
Signature Title
Signature Date

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