FORM 1023-EZ for PORTLAND LUMBERJACKS RFC

Field Data
EIN 81-1088529
Case Number EO-2017255-000031
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PORTLAND LUMBERJACKS RFC
Organization’s Mailing Address 4018 N MISSISSIPPI AVE APT 205
City PORTLAND
State OR
ZIP 97227
Accounting period End 12
Primary contact name SERGIO RIVERA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK ANTICH
VICE PRESIDENT
5925 N PRINCETON ST
PORTLAND OR 97203

Officer/Director/Trustee Two

SERGIO RIVERA
TREASURER
4018 N MISSISSIPPI AVE APT 205
PORTLAND OR 97227

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date
EIN 81-1088529
Case Number EO-2016028-000288
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PORTLAND LUMBERJACKS RFC
Organization’s Mailing Address 635 NE 241ST PL
City WOOD VILLAGE
State OR
ZIP 97060
Accounting period End 12
Primary contact name RICHARD LANKFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIAN GARDES
PRESIDENT
5427 N MONTANA AVE
PORTLAND OR 97217

Officer/Director/Trustee Two

RICHARD LANKFORD
TREASURER
635 NE 241ST PL
WOOD VILLAG OR 97060

Officer/Director/Trustee Three

SHAWN OHARA
SECRETARY
7033 N IDA AVE
PORTLAND OR 97203

Organization’s website LUMBERJACKSRUGBY.COM
Organization’s email LUMBERJACKSRUGBY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/2/2015
Organization Incorporation State OR
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: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 Yes
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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