FORM 1023-EZ for PATRIOT LACROSSE ASSOCIATION INC

Field Data
EIN 81-4699348
Case Number EO-2017044-000320
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATRIOT LACROSSE ASSOCIATION INC
Organization’s Mailing Address 1528 DOGWOOD ROAD
City CHARLESTON
State WV
ZIP 25314
Accounting period End 6
Primary contact name ERIC GADD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EDWARD TIFFEY
PRESIDENT
1344 MORNINGSIDE DRIVE
CHARLESTON WV 25314

Officer/Director/Trustee Two

KIP RICE
TREASURER
1528 DOGWOOD ROAD
CHARLESTON WV 25314

Officer/Director/Trustee Three

STEVE ODEKIRK
DIRECTOR
10 DRUID PLACE
CHARLESTON WV 25314

Officer/Director/Trustee Four

SAM SUTTON
DIRECTOR
4 COMSTOCK PLACE
CHARLESTON WV 25314

Officer/Director/Trustee Five

SCOTT WOOTEN
DIRECTOR
1305 LOUDON HEIGHTS
CHARLESTON WV 25314

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/15/2016
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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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