FORM 1023-EZ for LOCAL 528 SCHOLARSHIP FUND

Field Data
EIN 85-1510355
Case Number EO-2020210-000161
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LOCAL 528 SCHOLARSHIP FUND
Organization’s Mailing Address PO BOX 80462
City SEATTLE
State WA
ZIP 98108
Accounting period End 5
Primary contact name MICHELLE MCCANN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROSIE BERNARD
DIRECTOR
27219 212TH AVE SE
MAPLE VALLEY WA 98038

Officer/Director/Trustee Two

EDWARD CASE
DIRECTOR
1817 OAKES AVE
EVERETT WA 98201

Officer/Director/Trustee Three

NANCY NICKLES
DIRECTOR
914 24TH AVE E
SEATTLE WA 98112

Officer/Director/Trustee Four

JUSTIN PALACHUK
DIRECTOR
5830 TULALIP SHORES RD
TULALIP WA 98271

Officer/Director/Trustee Five

JAMAL ROBINSON
DIRECTOR
4726 SOUTH CENTER BLVD B103
TUKWILA WA 98188

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 JUSTIN PALACHUK
Signature Title DIRECTOR
Signature Date 7/23/2020

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