FORM 1023-EZ for KENTLAKE GIRLS BASKETBALL BOOSTER CLUB

Field Data
EIN 81-1329224
Case Number EO-2016167-000253
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KENTLAKE GIRLS BASKETBALL BOOSTER CLUB
Organization’s Mailing Address 18443 SE 279TH PL
City KENT
State WA
ZIP 98042
Accounting period End 9
Primary contact name MIKE JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MIKE JOHNSON
PRESIDENT
18443 SE 279TH PL
KENT WA 98042

Officer/Director/Trustee Two

TIM THIBERT
VICE PRESIDENT
26312 165TH PL SE
KEN WA 98042

Officer/Director/Trustee Three

JEFF DENCKLA
VP FUNDRAISING
1010 6TH AVE N
KENT WA 98032

Officer/Director/Trustee Four

BRENDA PETERSON
TREASURER
28912 186TH PL SE
KENT WA 98042

Officer/Director/Trustee Five

KATHY GILDEA
SECRETARY
22420 SE 331ST ST
AUBURN WA 98092

Organization’s website WWW.KENTLAKEGIRLSBASKETBALL.COM
Organization’s email KENTLAKEGIRLSBASKETBALL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/7/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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 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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