FORM 1023-EZ for PACIFIC NORTHWEST SUSSEX SPANIEL CLUB

Field Data
EIN 82-2983208
Case Number EO-2017279-000233
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PACIFIC NORTHWEST SUSSEX SPANIEL CLUB
Organization’s Mailing Address PO BOX 35
City BURLEY
State WA
ZIP 98322
Accounting period End 12
Primary contact name PATRICIA SHAW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICIA SHAW
PRESIDENT
PO BOX 35
BURLEY WA 98322

Officer/Director/Trustee Two

HOLLY PIEROG
VICE-PRESIDENT
2855 N JEROME ST
KINGMAN AZ 86420

Officer/Director/Trustee Three

CHERYL OZBIRN
TREASURER/SECRETARY
17507 153RD ST CT KPN
GIG HARBOR WA 98329

Officer/Director/Trustee Four

SANDRA ADAMS
BOARD OF DIRECTOR
PO BOX 116
ALVADORE OR 97409

Organization’s website HTTP://WWW.PNWSSC.ORG
Organization’s email PNWSSC@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/25/2004
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D60 - Other Services - Specialty Animals
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 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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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