FORM 1023-EZ for THURSTON MAT CLUB

Field Data
EIN 93-1316377
Case Number EO-2016127-000197
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THURSTON MAT CLUB
Organization’s Mailing Address 250 71ST PLACE
City SPRINGFIELD
State OR
ZIP 97478
Accounting period End 12
Primary contact name LACEY CARTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DENNIS HARADA
PRESIDENT
6646 B STREET
SPRINGFIELD OR 97478

Officer/Director/Trustee Two

LACEY CARTER
TREASURER
250 71ST PLACE
SPRINGFIELD OR 97478

Officer/Director/Trustee Three

CHERI ELLIS
VICE-PRESIDENT/SECRETARY
321 SOUTH 40TH STREET
SPRINGFIELD OR 97478

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/2/2014
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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