FORM 1023-EZ for CORVALLIS TRIATHLON CLUB

Field Data
EIN 38-3857485
Case Number EO-2015216-000131
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CORVALLIS TRIATHLON CLUB
Organization’s Mailing Address P O BOX X
City CORVALLIS
State OR
ZIP 97339
Accounting period End 12
Primary contact name WILLIAM WITT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM WITT
TREASURER
582 NW VAN BUREN AVENUE
CORVALLIS OR 97330

Officer/Director/Trustee Two

DAVID DICKSON
VICE PRESIDENT
7660 NW HOODVIEW CIR
CORVALLIS OR 97330

Officer/Director/Trustee Three

ROSCOE HUBNER
PRESIDENT
235 COUNTRY CLUB
ALBANY OR 97321

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2011
Organization Incorporation State OR
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: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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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