FORM 1023-EZ for LONG BEACH POLY LACROSSE BOOSTER CLUB INC

Field Data
EIN 81-4592728
Case Number EO-2016349-000377
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LONG BEACH POLY LACROSSE BOOSTER CLUB INC
Organization’s Mailing Address 329 AVENIDA GRANADA
City LONG BEACH
State CA
ZIP 90814
Accounting period End 12
Primary contact name MITCHELL LANSELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MITCHELL LANSDELL
PRESIDENT
329 AVENIDA GRANADA
LONG BEACH CA 90814

Officer/Director/Trustee Two

ADAM SHANDROW
VICE PRESIDENT
3764 CEDAR AVE
LONG BEACH CA 90807

Officer/Director/Trustee Three

JAMES KOVAL
SECRETARY
3333 KALLIN AVE
LONG BEACH CA 90808

Officer/Director/Trustee Four

JULIA GOUGH
TREASURER
6 RIVO ALTO CANAL
LONG BEACH CA 90803

Organization’s website LONGBEACHPOLYLAX.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/17/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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