FORM 1023-EZ for FAIRFAX COIN CLUB INC

Field Data
EIN 82-2872857
Case Number EO-2018333-000088
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAIRFAX COIN CLUB INC
Organization’s Mailing Address PO BOX 215
City VIENNA
State VA
ZIP 22183
Accounting period End 12
Primary contact name DARYL HAYNOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARYL HAYNOR
TREASURER
2778 MARSHALL LAKE DRIVE
OAKTON VA 22124

Officer/Director/Trustee Two

SUSAN VAN DER VEER
PRESIDENT
10802 MIDSUMMER DRIVE
RESTON VA 20191

Officer/Director/Trustee Three

PAT FLYNN
VICE PRESIDENT
2603 OLDWICK COURT
RESTON VA 20191

Officer/Director/Trustee Four

DAVID ELLISON
SECRETARY
702 TAMARACK WAY APT 2B
HERNDON VA 20170

Officer/Director/Trustee Five

BRIAN MORGAN
DIRECTOR
5354 SIDEBURN ROAD
FAIRFAX VA 22032

Organization’s website FAIRFAXCOINCLUB.COM
Organization’s email FAIRFAXCOINCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/17
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 DARYL HAYNOR
Signature Title TREASURER
Signature Date 11/27/18

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