FORM 1023-EZ for WYOMING COUNCIL ON PROBLEM GAMBLING

Field Data
EIN 36-4822255
Case Number EO-2015329-000340
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WYOMING COUNCIL ON PROBLEM GAMBLING
Organization’s Mailing Address 3529 PALEN RD
City CHEYENNE
State WY
ZIP 82007
Accounting period End 12
Primary contact name EDWARD ATCHISON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EDWARD ATCHISON
DIRECTOR
3529 PALEN RD
CHEYENNE WY 82007

Officer/Director/Trustee Two

ADELAIDE WILSON
DIRECTOR
146 US HWY 16 E SPACE 9
BUFFALO WY 82833

Officer/Director/Trustee Three

JOHN SHOFFSTALL
DIRECTOR
PO BOX 307
BEULAH WY 82712

Officer/Director/Trustee Four

VIRGINIA SHOFFSTALL
PRESIDENT/DIRECTOR
PO BOX 307
BEULAH WY 82712

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2006
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F54 - Gambling Addiction
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 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 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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