FORM 1023-EZ for SOUTHWORTH BOOSTER CLUB

Field Data
EIN 91-1401520
Case Number EO-2015113-000065
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHWORTH BOOSTER CLUB
Organization’s Mailing Address PO BOX 476
City YELM
State WA
ZIP 98597
Accounting period End 6
Primary contact name KIM HOLMES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRITTANY MEYER
PRESIDENT
4706 GALLUP DR SE
OLYMPIA WA 98513

Officer/Director/Trustee Two

JENNICA SCHOW
VICE PRESIDENT
7625 TERN CT SE
OLYMPIA WA 98513

Officer/Director/Trustee Three

LESLEE YOUCKTON
SECRETARY
16148 PRAIRIE CREEK LOOP
YELM WA 98597

Officer/Director/Trustee Four

KIM HOLMES
TREASURER
15338 91ST AVE SE
YELM WA 98597

Organization’s website NONE
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/2011
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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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