FORM 1023-EZ for LAKE STEVENS LACROSSE CLUB

Field Data
EIN 82-5475805
Case Number EO-2018135-000280
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE STEVENS LACROSSE CLUB
Organization’s Mailing Address 621 SR 9 NE PMB D-21
City LAKE STEVENS
State WA
ZIP 98258-9400
Accounting period End 12
Primary contact name LISA GERBER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAWN STAFFORD
PRESIDENT
603 89TH AVE SE
LAKE STEVENS WA 98258-9400

Officer/Director/Trustee Two

KAYLA CLARK
VICE PRESIDENT
8104 10TH PL NE
LAKE STEVENS WA 98258-9400

Officer/Director/Trustee Three

PATTY PELAYO
TREASURER
11220 19TH ST SE
LAKE STEVENS WA 98258-9400

Officer/Director/Trustee Four

LISA GERBER
SECRETARY
9020 2ND PL SE
LAKE STEVENS WA 98258-9400

Officer/Director/Trustee Five

JILL FORTNEY
COMMUNITY OUTREACH
11517 34TH SE NE
LAKE STEVENS WA 98258-9400

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/24/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O23 - Boys and Girls Clubs (Combined)
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LISA GERBER
Signature Title SECRETARY
Signature Date 5/9/18

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