FORM 1023-EZ for LAX 10-29

Field Data
EIN 84-4884642
Case Number EO-2020181-000421
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAX 10-29
Organization’s Mailing Address 597 N HIGH ST PO BOX 992
City WORTHINGTON
State OH
ZIP 43085-4103
Accounting period End 12
Primary contact name KATHI LEIGH KAHOUN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHI KAHOUN
PRESIDENT
6945 VILLAGE WOODS PL
WORTHINGTON OH 43085-2315

Officer/Director/Trustee Two

GREG KOCIBA
VICE PRESIDENT
477 OLENWOOD AVE
WORTHINGTON OH 43085-2245

Officer/Director/Trustee Three

LORI KOCIBA
TREASURER
477 OLENWOOD AVE
WORTHINGTON OH 43085-2245

Officer/Director/Trustee Four

MARY MOORMA
SECRETARY
368 PARK BLVD
WORTHINGTON OH 43085-3738

Organization’s website N/A
Organization’s email WOTOWN@1029LAX.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O01 - Alliance/Advocacy Organizations
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 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 KATHI KAHOUN
Signature Title PRESIDENT
Signature Date 6/26/2020

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