FORM 1023-EZ for NORTHWESTERN ARCHAEOLOGICAL CONSERVANCY

Field Data
EIN 82-1861542
Case Number EO-2017283-000343
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHWESTERN ARCHAEOLOGICAL CONSERVANCY
Organization’s Mailing Address 167 E MAPLE ST
City LEBANON
State OR
ZIP 97355
Accounting period End 12
Primary contact name DAVID E ATKIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KOREY DERRICK
PRESIDENT
4642 SE 43RD AVE
PORTLAND OR 97206

Officer/Director/Trustee Two

ROBERT UNGER
SECRETARY
1544 NW 4TH ST
REDMOND OR 97756

Officer/Director/Trustee Three

KAITLIN HAKANSON
TREASURER
316 MESA DR
KLAMATH FALLS OR 97601

Organization’s website WWW.NAC.NGO
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/6/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A05 - Research Institutes and/or Public Policy Analysis
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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
Signature Title
Signature Date

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