FORM 1023-EZ for MIDDLEBURY LACROSSE CORP

Field Data
EIN 80-0896335
Case Number EO-2015042-000136
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MIDDLEBURY LACROSSE CORP
Organization’s Mailing Address PO BOX 1201
City MIDDLEBURY
State IN
ZIP 46540-1201
Accounting period End 12
Primary contact name JAMES V WOODSMALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LISA GRABER
PRESIDENT DRECTOR
19394 WHISPERING HILL DR
BRISTOL IN 46507

Officer/Director/Trustee Two

HEATHER WOGOMAN
VICE PRESIDENT DIRECTOR
13347 CR 12
MIDDLEBURY IN 46540

Officer/Director/Trustee Three

CHASTITY GRISE
SECRETARY DIRECTOR
57277 BLACKHAWK DR
GOSHEN IN 46528

Officer/Director/Trustee Four

HEATHER RESER
TREASURER DIRECTOR
19410 DORCHESTER CT
BRISTOL IN 46507

Officer/Director/Trustee Five

ERIC LEE
AT-LARGE-MEMBER DIRECTOR
204 KRIDER DRIVE
MIDDLEBURY IN 46540

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/30/2015
Organization Incorporation State IN
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: 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 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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