FORM 1023-EZ for LSIL-1091 MUSEUM ASSOCIATION

Field Data
EIN 82-1173803
Case Number EO-2017226-000329
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LSIL-1091 MUSEUM ASSOCIATION
Organization’s Mailing Address 2470 CYPRESS AVE
City EUREKA
State CA
ZIP 95503
Accounting period End 12
Primary contact name DONALD C REED
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONALD C REED
PRESIDENT
2470 CYPRESS AVE
EUREKA CA 95503

Officer/Director/Trustee Two

JOHN O HOKMAN
SECRETARY
209 ELIZABETH DR
ARCATA CA 95521

Officer/Director/Trustee Three

CARL THODE
CHIEF FINANCIAL OFFICER
PO BOX 5605
EUREKA CA 95502

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A50 - Museum, Museum Activities
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 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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