FORM 1023-EZ for MID-WILLAMETTE VALLEY TRANSGENDER SUPPORT NETWORK

Field Data
EIN 84-3648260
Case Number EO-2020029-000529
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MID-WILLAMETTE VALLEY TRANSGENDER SUPPORT NETWORK
Organization’s Mailing Address 3875
City ALBANY
State OR
ZIP 97322
Accounting period End 12
Primary contact name TOM BIRCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELIJAH STUCKI
PRESIDENT
3875
ALBANY OR 97322

Officer/Director/Trustee Two

ERIN MACADAMS
SECRETARY
3875 DOGWOOD AVE SE
ALBANY OR 97322

Officer/Director/Trustee Three

CAMMI BROADBENT
TREASURER
3875 DOGWOOD AVE SE
ALBANY OR 97322

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/2019
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 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 ELIJAH STUCKI
Signature Title PRESIDENT
Signature Date 1/27/2020

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