FORM 1023-EZ for QUEEN ANNE QUICK STYX LACROSSE CLUB

Field Data
EIN 26-4400554
Case Number EO-2016012-000757
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name QUEEN ANNE QUICK STYX LACROSSE CLUB
Organization’s Mailing Address 2607 W BLAINE STREET
City SEATTLE
State WA
ZIP 98199
Accounting period End 10
Primary contact name TIFFANIE RANTA CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GEORGE BERGERON
DIRECTOR
2607 W BLAINE STREET
SEATTLE WA 98199

Officer/Director/Trustee Two

DAVID FITZGERALD
SECRETARY
2229 22ND AVE E
SEATTLE WA 98112

Officer/Director/Trustee Three

BRETT CAROLAN
TREASURER
3218 43RD AVE W
SEATTLE WA 98199

Officer/Director/Trustee Four

DEBORAH SIMPSON
REGISTRAR
2020 36TH AVE W
SEATTLE WA 98199

Organization’s website QUEENANNEQUICKSTYX.USLAXTEAMS.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/6/2009
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: No
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 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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