FORM 1023-EZ for AGATE LAKE ASSOCIATION INC

Field Data
EIN 47-3105480
Case Number EO-2015049-000155
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AGATE LAKE ASSOCIATION INC
Organization’s Mailing Address 9422 AGATE LAKE ROAD
City LAKE SHORE
State MN
ZIP 56468
Accounting period End 12
Primary contact name MICK JUSTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KEN PANGER
PRESIDENT
1412 8TH AVE SE
ST CLOUD MN 56304

Officer/Director/Trustee Two

DEBBIE FOX
TREASURER
14210 KENYON ST NE
HAM LAKE MN 55304

Officer/Director/Trustee Three

DONALD HOGER
VICE PRESIDENT SECRETARY
9422 AGATE LAKE ROAD
LAKE SHORE MN 56468

Organization’s website NONE
Organization’s email HOGER@NISSWA.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/12/2015
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C32 - Water Resource, Wetlands Conservation and Management
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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