FORM 1023-EZ for STAYTON SOCCER CLUB

Field Data
EIN 47-3582525
Case Number EO-2016224-000515
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STAYTON SOCCER CLUB
Organization’s Mailing Address 1308 N FIRST AVE
City STAYTON
State OR
ZIP 97383
Accounting period End 3
Primary contact name DEBI OBRYANT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTOPHER SHIELDS
PRESIDENT
455 GRIZZLY ST
AUMSVILLE OR 97383

Officer/Director/Trustee Two

MICHAEL REYNOLDS
VICE PRESIDENT
1308 N FIRST AVE
STAYTON OR 97383

Officer/Director/Trustee Three

DEBI OBRYANT
SECRETARY/TREASURER
PO BOX 842
STAYTON OR 97383-0842

Officer/Director/Trustee Four

JANCI BURNS
PARENT REPRESENTATIVE
1740 SHAFF RD
STAYTON OR 97383

Organization’s website HTTPS://WWW.FACEBOOK.COM/STAYTONSOCCERCLUB
Organization’s email STAYTONSOCCERTREASURER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/17/2014
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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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