FORM 1023-EZ for DUSTIN LAZOWSKI MEMORIAL FOUNDATION
| Field | Data |
|---|---|
| EIN | 82-5165701 |
| Case Number | EO-2018109-000372 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | DUSTIN LAZOWSKI MEMORIAL FOUNDATION |
| Organization’s Mailing Address | 10 E SCRANTON SUITE 202 |
| City | LAKE BLUFF |
| State | IL |
| ZIP | 60044-2540 |
| Accounting period End | 3 |
| Primary contact name | LYNN M FISHMAN |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
LYNN M FISHMAN
DIRECTOR
12900 W HEIDEN CIR UNIT 4405
LAKE BLUFF IL 60044-1077
Officer/Director/Trustee Two
THANH DOMBROE
DIRECTOR
W150N10098 WINDSONG CIR W
GERMANTOWN WI 53022-5291
Officer/Director/Trustee Three
JOEL CONELL
DIRECTOR
114W15257 VICKSBURG AVE
GERMANTOWN WI 53022-3527
| Organization’s website | DUSTINLAZOWSKIMEMORIAL.ORG |
|---|---|
| Organization’s email | INFO@DUSTINLAZOWSKIMEMORIAL.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 3/26/18 |
| Organization Incorporation State | IL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | Y12 - Fund Raising and/or Fund Distribution |
| 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 | 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 | LYNN M FISHMAN |
| Signature Title | DIRECTOR |
| Signature Date | 4/16/18 |
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