FORM 1023-EZ for LAKE ROOSEVELT WALLEYE CLUB

Field Data
EIN 91-1701360
Case Number EO-2018309-000276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE ROOSEVELT WALLEYE CLUB
Organization’s Mailing Address PO BOX 806
City KETTLE FALLS
State WA
ZIP 99141
Accounting period End 1
Primary contact name DIANE UNZEITIG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICK MILLER
PRESIDENT
482A HOTCHKISS RD
COLVILLE WA 99114

Officer/Director/Trustee Two

GERRY EICKERMAN
VICE PRESIDENT
3765 HILL LOOP RD
KETTLE FALLS MO 99141

Officer/Director/Trustee Three

DOUGLAS UNZEITIG
TREASURER
1240 S ASPEN RIDGE RD
KETTLE FALLS WA 99141

Officer/Director/Trustee Four

DENNIS SPAULDING
SECRETARY
2426 GILMORE RD
KETTLE FALLS WA 99141

Officer/Director/Trustee Five

JAMES TILLS
BOARD MEMBER
PO BOX 220
KETTLE FALLS WA 99141

Organization’s website LAKEROOSEVELTWALLEYECLUB.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/24/95
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N61 - Fishing, Hunting Clubs
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 Yes
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 DOUGLAS UNZEITIG
Signature Title TREASURER
Signature Date 11/1/18

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