FORM 1023-EZ for ANDERSON ISLAND COMMUNITY CLUB

Field Data
EIN 91-6054159
Case Number EO-2016067-000271
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANDERSON ISLAND COMMUNITY CLUB
Organization’s Mailing Address 11319 YOMAN ROAD
City ANDERSON ISLAND
State WA
ZIP 98303
Accounting period End 12
Primary contact name SIMONA MARTINEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JUDY OLSEN
PRESIDENT
14125 LYLE POINT RD
ANDERSON ISLAND WA 98303

Officer/Director/Trustee Two

LYNDA BAILE
VICE PRESDENT
11710 COUNTRY CLUB DRIVE
ANDERSON ISLAND WA 98303

Officer/Director/Trustee Three

SIMONA MARTINEZ
TREASURER
10720 MADRONA DRIVE
ANDERSON ISLAND WA 98303

Officer/Director/Trustee Four

DONNA BATTISHILL
SECRETARY
12916 91ST STREET CT
ANDERSON ISLAND WA 98303

Officer/Director/Trustee Five

LIANA CHASE
CORRESPONDING SECRETARY
9117 130TH AVENUE CT
ANDERSON ISLAND WA 98303

Organization’s website ANDERSONISLANDCC.ORG
Organization’s email SMARTINEZ1968@HOTMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/1930
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 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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