FORM 1023-EZ for DANA GRAY PARENTS CLUB

Field Data
EIN 46-2627711
Case Number EO-2014310-000194
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DANA GRAY PARENTS CLUB
Organization’s Mailing Address 1197 CHESTNUT STREET
City FORT BRAGG
State CA
ZIP 95437
Accounting period End 6
Primary contact name TINA ROSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TINA ROSE
PRESIDENT
13220 POINT CABRILLO DRIVE
MENDOCINO CA 95460

Officer/Director/Trustee Two

MARYANNE BARONI
VICE PRESIDENT
22300 BURROWS RANCH ROAD
FORT BRAGG CA 95437

Officer/Director/Trustee Three

NANCY BENNETT
SECRETARY
20741 FAWN LANE
FORT BRAGG CA 95437

Officer/Director/Trustee Four

KARI WALSH
TREASURER
22121 N PETALUMA AVE
FORT BRAGG CA 95437

Officer/Director/Trustee Five

CHENOA SIPILA
PARLIAMENTARIAN
567 S HARRISON ST
FORT BRAGG CA 95437

Organization’s website
Organization’s email DANAGRAYPARENTSCLUB@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/28/2013
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
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 Yes
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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