FORM 1023-EZ for MY LUCKY STARZ

Field Data
EIN 81-2148301
Case Number EO-2016102-000474
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY LUCKY STARZ
Organization’s Mailing Address PO BOX 1373
City NEDERLAND
State CO
ZIP 80466-1373
Accounting period End 12
Primary contact name DAVID CLAYTON WILLIAMSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LESLIE SEAL
EXECUTIVE DIRECTOR
960 ELDORADO AVE
NEDERLAND CO 80466

Officer/Director/Trustee Two

DAVID WILLIAMSON
ASSISTANT DIRECTOR
960 ELDORADO AVE
NEDERLAND CO 80466

Officer/Director/Trustee Three

KEN QUIGLEY
CHAIRMAN OF THE BOARD
260 EAST STREET APT 1
NEDERLAND CO 80466

Organization’s website MYLUCKYSTARZ.ORG
Organization’s email ADMIN@MYLUCKYSTARZ.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2016
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 Yes
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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