FORM 1023-EZ for LADY TIGERS SWIM DIVE BOOSTER CLUB

Field Data
EIN 47-4213189
Case Number EO-2015161-000538
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LADY TIGERS SWIM DIVE BOOSTER CLUB
Organization’s Mailing Address PO BOX 163
City FARMINGTON
State MN
ZIP 55024
Accounting period End 12
Primary contact name ADRIENNE JASINSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ADRIENNE JASINSKI
TREASURER
6711 FOREST ST
FARMINGTON MN 55024

Officer/Director/Trustee Two

TIMOTHY WILLIS
VICE PRESIDENT
17702 FORTUNE TRAIL
FARMINGTON MN 55024

Officer/Director/Trustee Three

EDWARD BRAY
PRESIDENT
17670 FORTUNE TRAIL
FARMINGTON MN 55024

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N66 - Tennis, Racquet Sports Clubs, Leagues
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 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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