FORM 1023-EZ for SEQUOIA VILLAGE

Field Data
EIN 47-3571718
Case Number EO-2015098-000358
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SEQUOIA VILLAGE
Organization’s Mailing Address 809 LAUREL STREET SUITE 813
City SAN CARLOS
State CA
ZIP 94070-3914
Accounting period End 12
Primary contact name TERI L K SHUGART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SCOTT MCMULLIN
DIRECTOR, PRESIDENT
7 DAFFODIL LANE
SAN CARLOS CA 94070-1552

Officer/Director/Trustee Two

DAVID MCCLURE
DIRECTOR, CHIEF FINANCIAL OFFICER
14 TASKER LANE
SAN CARLOS CA 94070-4427

Officer/Director/Trustee Three

LISA SHAREK
DIRECTOR, SECRETARY
2037 SAN CARLOS AVENUE
SAN CARLOS CA 94070-1929

Officer/Director/Trustee Four

VICTORIA KLINE COSLEY
DIRECTOR
1263 CHERRY STREET APT 305
SAN CARLOS CA 94070-3130

Officer/Director/Trustee Five

MAY WONG RATIU
DIRECTOR
3193 LA MESA DRIVE
SAN CARLOS CA 94070-4264

Organization’s website WWW.SEQUOIAVILLAGE.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W19 - Nonmonetary Support 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 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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