FORM 1023-EZ for JACKSON COUNTY LIONS CLUB 3608

Field Data
EIN 84-6036185
Case Number EO-2014272-000178
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACKSON COUNTY LIONS CLUB 3608
Organization’s Mailing Address 508 MAIN STREET BOX 144
City WALDEN
State CO
ZIP 80480
Accounting period End 6
Primary contact name JAMES CAROTHERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RICK CORNELISON
PRESIDENT
400 HARRISON STREET
WALDEN CO 80480

Officer/Director/Trustee Two

FRAN CLAYTON
SECRETARY
851 JCR 17A
WALDEN CO 80480

Officer/Director/Trustee Three

JAMES CAROTHERS
TREASURER
616 6TH STREET
WALDEN CO 80480

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/20/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
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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