FORM 1023-EZ for CAMP TO BELONG WA

Field Data
EIN 81-1484241
Case Number EO-2016055-000151
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAMP TO BELONG WA
Organization’s Mailing Address PO BOX 1002
City PORT ORCHARD
State WA
ZIP 98366
Accounting period End 12
Primary contact name APRIL VANGESEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DEB KENNEDY
PRESIDENT, DIRECTOR
14549 TALL FIRS LANE
PORT ORCHARD WA 98366

Officer/Director/Trustee Two

APRIL VANGESEN
VICE PRESIDENT, DIRECTOR
5457 E BLAISDELL LANE
PORT ORCHARD WA 98366

Officer/Director/Trustee Three

LENA MITCHELL
TREASURER
4153 WOOD RD E
PORT ORCHARD WA 98366

Officer/Director/Trustee Four

DAVID LEWIS-RANDOLPH
BOARD MEMBER
2345 S AINSWORTH
TACOMA WA 98405

Officer/Director/Trustee Five

PAIGE TRACY
BOARD MEMBER
17119 2ND ST KPN
LAKEBAY WA 98349

Organization’s website WWW.CAMPTOBELONGWA.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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