FORM 1023-EZ for TIMBER LAKE JOB CORPS CIVILIAN CONSERVATION STUDENT GOVT ASSN INC

Field Data
EIN 83-0531289
Case Number EO-2018284-000189
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name TIMBER LAKE JOB CORPS CIVILIAN CONSERVATION STUDENT GOVT ASSN INC
Organization’s Mailing Address 59868 E HIGHWAY 224
City ESTACADA
State OR
ZIP 97023
Accounting period End 12
Primary contact name JOSEPH Q KAUFMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VERNON TAYLOR
DIRECTOR
59868 E HIGHWAY 224
ESTACADA OR 97023

Officer/Director/Trustee Two

SUSAN GUMMERSON
DIRECTOR
59868 E HIGHWAY 224
ESTACADA OR 97023

Officer/Director/Trustee Three

SEDDRICK SAMPSON
SGA PRESIDENT
59868 E HIGHWAY 224
ESTACADA OR 97023

Officer/Director/Trustee Four

ANGEL RENTERIA
SGA VICE PRESIDENT
59868 E HIGHWAY 224
ESTACADA OR 97023

Officer/Director/Trustee Five

SHANCE BARNES
SGA SECRETARY/TREASURER
59868 E HIGHWAY 224
ESTACADA OR 97023

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/16/17
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B80 - Student Services, Organizations of Students
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 SUSAN GUMMERSON
Signature Title DIRECTOR
Signature Date 10/9/18

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