FORM 1023-EZ for CLEARWATER LAKE ASSOCIATION INC

Field Data
EIN 30-0791105
Case Number EO-2014342-000446
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEARWATER LAKE ASSOCIATION INC
Organization’s Mailing Address 15479 LADYSLIPPER LANE
City DEERWOOD
State MN
ZIP 56444
Accounting period End 12
Primary contact name LOUISE SELISKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY PERKINS
CHAIR, DIRECTOR
5600 HIBISCUS AVENUE
EDINA MN 55435

Officer/Director/Trustee Two

LOUISE SELISKI
TREASURER, DIRECTOR
15479 LADYSLIPPER LANE
DERWOOD MN 56444

Officer/Director/Trustee Three

KATHRYN PETERSON
VICE-CHAIR, DIRECTOR
15409 LADYSLIPPER LANE
DEERWOOD MN 56444

Officer/Director/Trustee Four

BARB SCHMITZ
SECRETARY, DIRECTOR
2643 NEW CENTURY PLACE EAST
MAPLEWOOD MN 55119

Officer/Director/Trustee Five

CHARLES LICK
DIRECTOR
6 FLETCHER PLACE
HOPKINS MN 55305

Organization’s website NA
Organization’s email PKATHY10@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/22/2014
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C99 - Environmental Quality, Protection, and Beautification N.E.C.
Organization’s purpose Charitable: Yes
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 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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