FORM 1023-EZ for EMERALD RIDGE LACROSSE CLUB

Field Data
EIN 81-2578765
Case Number EO-2016133-000216
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMERALD RIDGE LACROSSE CLUB
Organization’s Mailing Address 17209 134TH AVE CT E
City PUYALLUP
State WA
ZIP 98374
Accounting period End 9
Primary contact name NORMAN DILLON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NORMAN DILLON
PRESIDENT
17209 134TH AVE CT E
PUYALLUP WA 98374

Officer/Director/Trustee Two

CANDI VERHOEVEN
DIRECTOR
17123 85TH AVE CT E
PUYALLUP WA 98375

Officer/Director/Trustee Three

JAMIE BOSTICK
DIRECTOR
11717 169TH ST CT E
PUYALLUP WA 98374

Officer/Director/Trustee Four

DARREN HELLE
DIRECTOR
12615 172ND ST
PUYALLUP WA 98274

Organization’s website EMERALDRIDGELAX.ORG
Organization’s email NORM.EMERALDRIDGELAX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/2/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N02 - Management & Technical Assistance
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 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 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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