FORM 1023-EZ for JOSEPH LANE MIDDLE SCHOOL PARENT STAFF ASSOICATION

Field Data
EIN 81-1096187
Case Number EO-2016020-000134
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JOSEPH LANE MIDDLE SCHOOL PARENT STAFF ASSOICATION
Organization’s Mailing Address 2153 NE VINE ST
City ROSEBURG
State OR
ZIP 97470
Accounting period End 7
Primary contact name JOHN A TALLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KELLEY JANZEN
PRESIDENT
145 WOODBERRY LANE
ROSEBURG OR 97471

Officer/Director/Trustee Two

STEPHANIE REID
CO-PRESIDENT
1027 NE LINCOLN ST
ROSEBURG OR 97470

Officer/Director/Trustee Three

JUANITA CAMPBELL
VICE-PRESIDENT
122 TEAL LANE
ROSEBURG OR 97471

Officer/Director/Trustee Four

YVETTE FOX
SECRETARY
773 NE CLOVER AVE
ROSEBURG OR 97470

Officer/Director/Trustee Five

JENNIFER NESTRIPKE
TREASURER
3133 NE DOUGLAS AVE
ROSEBURG OR 97470

Organization’s website WWW.JOLANEPSA.WEEBLY.COM
Organization’s email JOLANEPSA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/14/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B94 - Parent/Teacher Group
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
Signature Title
Signature Date

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