FORM 1023-EZ for DOUGLAS COUNTY SAFETY ASSCOCIATION

Field Data
EIN 46-4520760
Case Number EO-2014346-000362
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOUGLAS COUNTY SAFETY ASSCOCIATION
Organization’s Mailing Address PO BOX 1185
City ROSEBURG
State OR
ZIP 97470
Accounting period End 12
Primary contact name STEPHEN T LUSCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PETE KIMBREL
CHAIR
814 AIRWAY AVE
SUTHERLIN OR 97474

Officer/Director/Trustee Two

DUANE GRANGE
VICE CHAIR
PO BOX 71250
SPRINGFIELD OR 97475

Officer/Director/Trustee Three

RICK LONG
SECRETARY
10599 OLD HWY 99 SOUTH
DILLARD OR 97432

Officer/Director/Trustee Four

STEPHEN LUSCH
TREASURER
1297 NE GRANDVIEW DRIVE
ROSEBURG OR 97470

Officer/Director/Trustee Five

SHIRLEY COUNTS
PROGRAM CO-CHAIR
1036 SE DOUGLAS
ROSEBURG OK 97470

Organization’s website N/A
Organization’s email DCSAOREGON@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/2014
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M40 - Safety Education
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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