FORM 1023-EZ for HERMISTON YOUTH LACROSSE

Field Data
EIN 20-8716796
Case Number EO-2016061-000110
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HERMISTON YOUTH LACROSSE
Organization’s Mailing Address 80294 HORNSBY LANE
City HERMISTON
State OR
ZIP 97838
Accounting period End 12
Primary contact name TIFFANY PALMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANDRE ALLISON
PRESIDENT
200 W MOORE
HERMISTON OR 97838

Officer/Director/Trustee Two

TIFFANY PALMER
SECRETARY/TREASURER
80294 HORNSBY LANE
HERMISTON OR 97838

Officer/Director/Trustee Three

SCOTT PURSWELL
OFFICER
310 E MCKINNEY
HERMISTON OR 97838

Officer/Director/Trustee Four

AARON FEIGUM
OFFICER
32674 E PUNKIN CTR ROAD
HERMISTON OR 97838

Officer/Director/Trustee Five

TRAMPIS PALMER
OFFICER
80294 HORNSBY LANE
HERMISTON OR 97838

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/2007
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: No
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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