FORM 1023-EZ for THOMAS LAKE PARENT COMMITTEE

Field Data
EIN 86-2310283
Case Number EO-2021097-000145
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THOMAS LAKE PARENT COMMITTEE
Organization’s Mailing Address 4350 THOMAS LAKE RD
City EAGAN
State MN
ZIP 55122
Accounting period End 12
Primary contact name AMANDA DUSTAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMANDA DUSTAN
PRESIDENT
2086 VIBURNUM TRAIL
EAGAN MN 55122

Officer/Director/Trustee Two

MICHELLE PETERKA-KOHLWEISS
OFFICER
1866 COVINGTON LANE
EAGAN MN 55122

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/10/2021
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MICHELLE PETERKA-KOHLWEISS
Signature Title OFFICER
Signature Date 3/10/2021

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