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Organization Information <br /> 8. Enter as much information about your organization as possible. Providing complete and <br /> accurate details will help ensure your application can be reviewed efficiently and may <br /> reduce the need for follow-up requests. <br /> ORGANIZATION DETAILS <br /> Organization Information <br /> Name of 501(c)(3)Organization As It Appears on IRS Forms" <br /> Enter here <br /> Physical Address <br /> Address 1 Address 2 <br /> Enter here Enter here <br /> City State Zip <br /> Enter here --t=_r here Enter here <br /> 9. Once all organization information has been entered, click Save to save your changes and <br /> exit the page. <br /> Am any officers,executive staff,or irdividuals wfth a signffic®r0...trolling influence—the nonprofit's decisions ar operations in the 501(c)(3)oureenfly employed as oHicers or <br /> emp€oyees of the County of Hawaii? <br /> No <br /> Provide the na me(s)of the officers,executive staff,ar individuals with a sig,ificantfwntrollinginfluence over the nanpmTit's decisions or operations in the 501(c)(3)employed as <br /> oHicer(s)or employees)of the County of H—AT <br /> Executive Officer 1;Executive Officer 2 <br /> Authorized Personnel <br /> Legal Name of Authorized Signer Authorized Signer Title End Date of Authorized Signer Term <br /> Authorized Signer Authorized Signer Title 62l2012027 CS <br /> Authorized Signer Email Address Authorized Signer Phone Number <br /> signer@email.com (780)686-8089 <br /> Does the 5D1(c)[3)have a Secondary Authorized Signer? <br /> No <br /> Canrel <br />