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        <StateAbbreviationCd>MI</StateAbbreviationCd>
        <ZIPCd>49047</ZIPCd>
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        <ZIPCd>49047</ZIPCd>
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      <PreparerPersonNm>Julie Schoff</PreparerPersonNm>
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      <MembershipDuesAmt>405</MembershipDuesAmt>
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          <CityNm>Dowagiac</CityNm>
          <StateAbbreviationCd>MI</StateAbbreviationCd>
          <ZIPCd>49047</ZIPCd>
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        <PhoneNum>2697576885</PhoneNum>
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      <ForeignOfficeInd>false</ForeignOfficeInd>
      <DonorAdvisedFndsInd>false</DonorAdvisedFndsInd>
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      <TanningServicesProvidedInd>false</TanningServicesProvidedInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
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        <OtherDirectExpensesPullTabsAmt>2047</OtherDirectExpensesPullTabsAmt>
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        <CashPrizesTotalGamingAmt>19519</CashPrizesTotalGamingAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Description of other expenses Part I line 16</FormAndLineReferenceDesc>
        <ExplanationTxt>Description AmountDepreciation from 4562 6,006BANK CHARGES 451SUPPLIES 742LICENSE FEES 591SALES TAX 1,744MISC 124CANTEEN COSTS 14,843INSURANE 5,857GAMING ACTIVITIES 2,047OFFICE 179</ExplanationTxt>
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