FORM 1023-EZ for DUBSEA COMMUNITY SPORTS FOUNDATION

Field Data
EIN 87-1532709
Case Number EO-2021230-000409
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DUBSEA COMMUNITY SPORTS FOUNDATION
Organization’s Mailing Address 10059 8TH AVE SW
City SEATTLE
State WA
ZIP 98146
Accounting period End 12
Primary contact name MARK V JORDAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUSTIN MOSER
DIRECTOR
26285 238TH LN SE APT P304
MAPLE VALLEY WA 98038

Officer/Director/Trustee Two

GREG LILLIEHAUG
DIRECTOR
118332 9TH AVE SW
SEATTLE WA 98146

Officer/Director/Trustee Three

PATRICK MCCOLLUM
DIRECTOR
15503 66TH AVE E
PUYALLUP WA 98375

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/25/2021
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 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 JUSTIN MOSER
Signature Title DIRECTOR
Signature Date 8/16/2021

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