FORM 1023-EZ for 3 OF A KIND

Field Data
EIN 81-5030823
Case Number EO-2017034-000176
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 3 OF A KIND
Organization’s Mailing Address 505 PINE STREET APT 202
City CLEARWATER
State MN
ZIP 55320
Accounting period End 12
Primary contact name SHAWN P THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAWN THOMAS
PRESIDENT
1070 MITCHELL AVENUE
CLEARWATER MN 55320

Officer/Director/Trustee Two

DALE ERGEN
VICE PRESIDENT
273 DOGWOOD DRIVE
ANNANDALE MN 55302

Officer/Director/Trustee Three

KAREN ERGEN
TREASURER
273 DOGWOOD DRIVE
ANNANDALE MN 55302

Officer/Director/Trustee Four

TAMMY MATVICK
SECRETARY
16750 160TH AVENUE
FOLEY MN 56329

Officer/Director/Trustee Five

DAVID PEDERSON
ROAD CAPTAIN
1015 MAIN STREET
CLEARWATER MN 55320

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2017
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
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 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 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
Signature Title
Signature Date

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