FORM 1023-EZ for SHAVER LAKE LIONS CHARITABLE FOUNDATION

Field Data
EIN 82-2630350
Case Number EO-2017243-000175
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHAVER LAKE LIONS CHARITABLE FOUNDATION
Organization’s Mailing Address 36280 CRESSMAN ROAD
City SHAVER LAKE
State CA
ZIP 93664
Accounting period End 6
Primary contact name JANET PARR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JANET PARR
PRESIDENT
36280 CRESSMAN ROAD
SHAVER LAKE CA 93664

Officer/Director/Trustee Two

DENNIS V HOFFMAN
VP
44884 AUBERRY ROAD
AUBERRY CA 93602

Officer/Director/Trustee Three

PETER VAN VLEET
TREAS/SEC
36280 CRESSMAN
SHAVER LAKE CA 93664

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
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 Yes
One Third Support Gifts No
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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