FORM 1023-EZ for LEGACY PARKOUR

Field Data
EIN 83-2604807
Case Number EO-2018341-000451
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEGACY PARKOUR
Organization’s Mailing Address 4380 SW MACADAM AVE SUITE 190
City PORTLAND
State OR
ZIP 97239
Accounting period End 12
Primary contact name MARIA F DI MICELI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTHEW ANTIS
PRESIDENT & DIRECTOR
4380 SW MACADAM AVE STE 190
PORTLAND OR 97239

Officer/Director/Trustee Two

RYLAND LANAGAN
SECRETARY & DIRECTOR
4380 SW MACADAM AVE STE 190
PORTLAND OR 97239

Officer/Director/Trustee Three

RYAN BILLUPS
TREASURER & DIRECTOR
4380 SW MACADAM AVE STE 190
PORTLAND OR 97239

Organization’s website
Organization’s email MATT@LEGACYPARKOUR.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/21/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 MATTHEW ANTIS
Signature Title PRESIDENT & DIRECTOR
Signature Date 12/5/18

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