FORM 1023-EZ for LIONS CLUB OF DYCKESVILLE FOUNDATION INC

Field Data
EIN 47-2564548
Case Number EO-2014363-000182
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIONS CLUB OF DYCKESVILLE FOUNDATION INC
Organization’s Mailing Address E524 THIRY DAEMS RD
City LUXEMBURG
State WI
ZIP 54217
Accounting period End 12
Primary contact name ATTORNEY HERBERT C LIEBMANN III
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRAD TANCK
PRESIDENT
5253 BAY MEADOW TR
LUXEMBURG WI 54217

Officer/Director/Trustee Two

JEFF DORNER
TREASURER
E524 THIRY DAEMS RD
LUXEMBURG WI 54217

Officer/Director/Trustee Three

PETER ANDRE
REGISTERED AGENT
9004 CTY RD X
FORESTVILLE WI 54213

Officer/Director/Trustee Four

SCOTT DAY
VICE PRESIDENT
6261 VANWOOD LN
LUXEMBURG WI 54217

Officer/Director/Trustee Five

JILL BERNHARDT
SECRETARY
5609 CTY K
NEW FRANKEN WI 54229

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/4/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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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