FORM 1023-EZ for LAKE MELVIN YACHT CLUB INC

Field Data
EIN 46-1865770
Case Number EO-2015146-000137
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE MELVIN YACHT CLUB INC
Organization’s Mailing Address 7136 LEE ROAD
City LODI
State WI
ZIP 53555
Accounting period End 12
Primary contact name DARRELL STATZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTINE BENESH
PRESIDENT
7136 LEE ROAD
LODI WI 53555

Officer/Director/Trustee Two

DARRELL STATZ
TREASURER
406 KARLS LANE
DANE WI 53529

Officer/Director/Trustee Three

REBECCA HAUGEN
VICE PRESIDENT
204 WEST STREET
DANE WI 53529

Officer/Director/Trustee Four

MARY MAERZ
SECRETARY
220 WEST STREET
DANE WI 53529

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/21/2006
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P60 - Emergency Assistance (Food, Clothing, Cash)
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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