FORM 1023-EZ for LAKESHORE REGIONAL CHILD ADVOCACY CENTER INC

Field Data
EIN 37-1829968
Case Number EO-2016350-000281
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKESHORE REGIONAL CHILD ADVOCACY CENTER INC
Organization’s Mailing Address 885 BADGER CIRCLE
City GRAFTON
State WI
ZIP 53024
Accounting period End 12
Primary contact name MICHAEL R HAAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHERI FARNSWORTH
PRESIDENT
596 HWY D
BELGIUM WI 53004

Officer/Director/Trustee Two

LINDA KRIEG
VICE PRESIDENT
W74 N755 SPRUCE AVENUE
CEDARBURG WI 53012

Officer/Director/Trustee Three

JULIE MAULE
SECRETARY
4086 DUNST DRIVE
WEST BEND WI 53095

Officer/Director/Trustee Four

STACY BODEN
TREASURER
735 MAPLE AVENUE
OOSTBURG WI 53070

Officer/Director/Trustee Five

ANN BACHRACH
DIRECTOR
N2040 PINE BEACH ROAD S
OOSTBURG WI 53070

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/7/2016
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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