FORM 1023-EZ for MD 19 G3 LIONS VISION FOUNDATION

Field Data
EIN 83-1395218
Case Number EO-2018214-000295
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MD 19 G3 LIONS VISION FOUNDATION
Organization’s Mailing Address PO BOX 111
City ABERDEEN
State WA
ZIP 98520
Accounting period End 6
Primary contact name HAROLD WARREN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HAROLD WARREN
INCORPORATOR
1630 CHILTON ROAD
ABERDEEN WA 98520

Officer/Director/Trustee Two

ROD MAYTE
DIRECTOR
PO BOX 1128
COSMOPOLIS WA 98537

Officer/Director/Trustee Three

ROBERT BRADEN
DIRECTOR
517 W SIXTH ST
ABERDEEN WA 98520

Officer/Director/Trustee Four

RICHARD WOODS
DIRECTOR
550 BALLENTINE ST
RAYMOND WA 98557

Officer/Director/Trustee Five

SEPPO TUOMINEN
DIRECTOR
4110 BUCHANAN ST
HOQUIAM WA 98550

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/25/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name HAROLD WARREN
Signature Title INCORPORATOR
Signature Date 7/31/18

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