FORM 1023-EZ for LAWRENCE ACTION CIVITAN CLUB

Field Data
EIN 81-3694552
Case Number EO-2016344-000270
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAWRENCE ACTION CIVITAN CLUB
Organization’s Mailing Address PO BOX 442164
City LAWRENCE
State KS
ZIP 66044-2164
Accounting period End 9
Primary contact name FRANK KELLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON HOLBERT
PRESIDENT
PO BOX 442164
LAWRENCE KS 66044-2164

Officer/Director/Trustee Two

JERRY TOTTEN
PRESIDENT ELECT
PO BOX 442164
LAWRENCE KS 66044-2164

Officer/Director/Trustee Three

REBEKAH HOLBERT
SECRETARY
PO BOX 442164
LAWRENCE KS 66044-2164

Officer/Director/Trustee Four

MARCIA DECHAND
TREASURER
PO BOX 442164
LAWRENCE SC 66044-2164

Officer/Director/Trustee Five

LYNN ELLIS
DIRECTOR
PO BOX 442164
LAWRENCE KS 66044-2164

Organization’s website NONE
Organization’s email LAWRENCECIVITAN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/11/2016
Organization Incorporation State KS
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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