FORM 1023-EZ for EVERGREEN LACROSSE BOOSTER CLUB

Field Data
EIN 27-5410524
Case Number EO-2017180-000370
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EVERGREEN LACROSSE BOOSTER CLUB
Organization’s Mailing Address 27015 NE HATHAWAY ROAD
City CAMAS
State WA
ZIP 98607
Accounting period End 5
Primary contact name MARSHA SHEPHERD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARSHA SHEPHERD
PRESIDENT
27015 NE HATHAWAY ROAD
CAMAS WA 98607

Officer/Director/Trustee Two

EDITH HAYDEN
SECRETARY
27015 NE HATHAWAY ROAD
CAMAS WA 98607

Officer/Director/Trustee Three

JENN LEE
VICE PRESIDENT
9509 SE 13TH STREET
VANCOUVER WA 98664

Officer/Director/Trustee Four

JEAN PETERS
TREASURY
9509 SE 13TH STREET
VANCOUVER WA 98664

Organization’s website
Organization’s email EVERGREENLAXCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/29/2016
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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
Signature Title
Signature Date

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