FORM 1023-EZ for OLYMPIC MOUNTAIN RESPONSE TEAM

Field Data
EIN 83-1654072
Case Number EO-2018235-000491
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OLYMPIC MOUNTAIN RESPONSE TEAM
Organization’s Mailing Address 632 NW BROOKHILL LANE
City HILLSBORO
State OR
ZIP 97124
Accounting period End 12
Primary contact name TANYA BARBA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TANYA BARBA
DIRECTOR
632 NW BROOKHILL LANE
HILLSBORO OR 97124

Officer/Director/Trustee Two

DEREK RANDLES
DIRECTOR
321 NE VALLEYSIDE LANE
TAHUYA WA 98588

Officer/Director/Trustee Three

JAMES MILLION
DIRECTOR
177 NE MAPLEWOOD CT
BELFAIR WA 98528

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/31/17
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y99 - Mutual/Membership Benefit Organizations, Other N.E.C.
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 TANYA BARBA
Signature Title DIRECTOR
Signature Date 8/21/18

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