FORM 1023-EZ for CHURCHILL LANCERS BOYS SOCCER ASSOCIATION

Field Data
EIN 36-4902813
Case Number EO-2019114-000222
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHURCHILL LANCERS BOYS SOCCER ASSOCIATION
Organization’s Mailing Address 3325 PARK HILLS DRIVE
City EUGENE
State OR
ZIP 97405
Accounting period End 12
Primary contact name ERIC PETERON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIC PETERSON
BOARD PRESIDENT
3325 PARK HILLS DRIVE
EUGENE OR 97405

Officer/Director/Trustee Two

SUSAN KELLY MITCHELL
VICE PRESIDENT
30817 BLANTON ROAD
EUGENE OR 97405

Officer/Director/Trustee Three

SARA PESTA
SECRETARY
1920 W 24TH AVE
EUGENE OR 97405

Officer/Director/Trustee Four

TY OHRTMAN
CHAIR
4840 BROOKWOOD ST
EUGENE OR 97405

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - 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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ERIC PETERSON
Signature Title BOARD PRESIDENT
Signature Date 4/20/19

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