FORM 1023-EZ for FIVE ACRE SCHOOL PARENT SERVICE ORGANIZATION

Field Data
EIN 91-1900913
Case Number EO-2017026-000115
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FIVE ACRE SCHOOL PARENT SERVICE ORGANIZATION
Organization’s Mailing Address 515 LOTZGESELL RD
City SEQUIM
State WA
ZIP 98382-8074
Accounting period End 6
Primary contact name JAMES STARR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES STARR
CHAIR
338 HUNT RD
PORT ANGELES WA 98363-8572

Officer/Director/Trustee Two

MICHELLE LUCIER
CO-CHAIR
154 BIG SKY LN
SEQUIM WA 98382-7828

Officer/Director/Trustee Three

AMBER TJEMSLAND
SECRETARY
686 BRIGADOON BLVD
SEQUIM WA 98382-8136

Officer/Director/Trustee Four

HEIDI VANDENBERG
TREASURER
2464 BLUE MOUNTAIN RD
PORT ANGELES WA 98362-8216

Organization’s website
Organization’s email PSO@FIVEACRESCHOOL.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/13/2009
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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