FORM 1023-EZ for LYNNWOOD EXPRESSIONS BOOSTER CLUB

Field Data
EIN 46-5491151
Case Number EO-2015125-000089
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LYNNWOOD EXPRESSIONS BOOSTER CLUB
Organization’s Mailing Address PO BOX 2963
City KIRKLAND
State WA
ZIP 98083-2963
Accounting period End 12
Primary contact name KELLEY SCACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KERI MJELTEVIK
PRESIDENT
2111 WESTLAKE AVENUE N SUITE 401
SEATTLE WA 98109

Officer/Director/Trustee Two

JACKIE WOFFORD
VICE PRESIDENT
221 116TH ST SE
EVERETT WA 98208

Officer/Director/Trustee Three

KELLEY SCACE
TREASURER
P0 BOX 2963
KIRKLAND WA 98083-2963

Officer/Director/Trustee Four

VAISHALI HARWALKAR
SECRETARY
3989 NE 170TH PLACE
BELLEVUE WA 98008

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/22/2014
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
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 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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