FORM 1023-EZ for PELL LAKE LAKE ASSOCIATION

Field Data
EIN 47-4404521
Case Number EO-2015183-000246
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PELL LAKE LAKE ASSOCIATION
Organization’s Mailing Address PO BOX 855
City PELL LAKE
State WI
ZIP 53157
Accounting period End 12
Primary contact name TORY SCHUTTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TORY SCHUTTE
PRESIDENT
W930 EAU CLAIRE ROAD
GENOA CITY WI 53128

Officer/Director/Trustee Two

SHERYL CAVANAUGH
OFFICER
N1174 ROSEWOOD DR
PELL LAKE WI 53157

Officer/Director/Trustee Three

WILLIAM HAGMEIER
SECRETARY/TREASURER
N1492 CLOVER ROAD
LAKE GENEVA WI 53147

Organization’s website
Organization’s email TORYGBB@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/21/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C32 - Water Resource, Wetlands Conservation and Management
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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