Text formatting has been added to this 1023 APPLICATION FORM.


DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
P.O. BOX 2508
CINCINNATI, OH 45201

Date: Jan. 31, 2003

CHIPUTNETICOOK LAKES INTERNATIONAL CONSERVANCY
c/o WILLIAM P. WALTON III
100 COLD INDIAN SPRING RD.
OCEAN-WAYSIDE, NJ 07712-0000

Employer Identification Number: 03-0465585
DLN: 17053316049012
Contact Person: L. WAYNE BOTHE - ID #31462
Contact Telephone Number: (877) 829-5500
Accounting Period Ending: December 31
Foundation Status Classification: 509 (a) (1)
Advance Ruling Period Begins: April 12, 2002
Advance Ruling Period Ends: December 31, 2006
Addendum Applies: No

You are required to make your annual information return, Form 990 or Form 990-EZ, available for public inspection for three years after the later of the due date of the return or the date the return is filed. You are also required to make available for public inspection
your exemption application, any supporting documents, and your exemption letter. Copies of these documents are also required to be provided to any individual upon written or in person request without charge other than reasonable fees for copying and postage. You may fulfill this requirement by placing these documents on the Internet. Penalties may be imposed for failure to comply with theses requirements.


Original Application for Exempt Status

Form 1023, Part I: Page 1

Line 1a: Name Chiputneticook Lakes International Conservancy
Line 1b: LEAVE BLANK
Line 1c: Address P. O. Box 85
Line 1d: Town, State, Zip Orient, Maine 04471-0085
Line 2: EIN 03-0465585

Line 3: Person to be contacted for more information:
William P. Walton, III - 732-775-0540 or 732-922-1322 res.

Line 4: Acctng. Period Ends December 31, 2002
Line 5: Date Formed April 9, 2002 de facto April 12, 2002 de jure
Line 6: LEAVE BLANK
Line 7: Applied Previously? NO
Line 8: Required to file Form 990? YES [No - See Advance Ruling letter]
Line 9: Filed tax returns previously? NO
Line 10: Type of Organization a) Corporation

Conformed Copy of Organizing Documents

Signature Debra Hannigan, President - Oct. 24, 2002

Form 1023, Part II, Page 2,

Line 1: The Chiputneticook Lakes International Conservancy, Inc. will act as a membership based lake association of both lakefront property owners who choose to affiliate and other individuals who choose to affiliate with the organization. The area covered is in rural northeastern Maine on the border with New Brunswick, Canada between Orient, ME and North Lake, NB in the north and Vanceboro, ME and St. Croix, NB in the south, a distance of about 40 miles.

The Chiputneticook Lakes International Conservancy, Inc. (hereinafter CLIC, Inc.) was formed de facto on April 9, 2002 and was recognized de jure on April 12, 2002 by the State of Maine. We have had only one activity other than 1) the initial incorporation meeting and on June 2, 2002, 2) our first Board of Directors meeting. The activity was the hosting of a dinner with informational speakers from the Maine Division of Inland Fish & Wildlife and the Maine Warden’s Service. We plan several membership activities this summer and have named the chairman of our Endowments, Bequests and Grants Committee to start to plan the charitable activities in our future.

Preceding the formation of CLIC, Inc., an unincorporated group of both lakefront landowners and non-landowners had existed since the summer of 1992 and acted as a “lake association,” their only income being dues and contributions from their own membership. Over those ten years, that organization accomplished many worthwhile activities and projects and represented well, all those who had an interest in what is known as the Chiputneticook Lakes area of eastern Maine and western New Brunswick, Canada, the five Chiputneticook Lakes forming the boundary between Maine and New Brunswick. The overwhelming majority of members are Americans with only 25-40 Canadian members. More than 450 individuals and families have at one time or another been associated with that organization (hereinafter, CLIC) with the active rolls currently totalling more than 255 individuals and families.

With CLIC’s current nine board members being named in the incorporation papers as CLIC, Inc’s initial Board of Directors, it is assumed that CLIC, Inc. will continue much of the work initiated by CLIC in addition to undertaking new projects and additional charitable work.

It is too early in our short history to know in what direction the CLIC, Inc. Board of Directors will lead the corporation, but the following narrative seeks to describe the activities that CLIC, the association has undertaken in the past and it is assumed that CLIC, Inc. will continue that good work.

All of the association’s past activities were carried out voluntarily by members and committees of members along with the officers and board of directors as the association has never directly employed any person. All work has been volunteer (except those few professional services that were deemed necessary by the CLIC Board of Directors and the services of some local tradesmen for products that the association had purchased.

1) The association has made significant donations to various Maine and New Brunswick non-profit organizations including: The St. Croix International Waterway Commission, an arm of the International Joint Commission (several donations of $500.00 or more), The Southwestern New Brunswick Stakeholders ($500.00 in 2000), and most recently (April 2002) has committed a $5,000.00 contribution( through the Woodie Wheaton Land Trust (EIN 01-0494342), the New England Forestry Foundation, the St. Croix International Waterway Commission and the Land for Maine’s Future Board) to the effort to purchase a 500 foot wide strip of more than 50 miles of remote Maine shoreline, 16 miles of that distance on one of our Chiputneticook Lakes.

2) The association has purchased and provided three large fish rearing tanks to three local elementary schools for science projects. Annually we provide Atlantic Salmon eggs for the school children to incubate, hatch, raise and then finally release into local waters. This project was started in 1995 and the cost of each tank is in the vicinity of $1500.00. The ongoing annual cost is relatively low.

3) Since it’s inception, the association has transmitted a quarterly newsletter to it’s members and others who have shown an interest in our ideals and efforts. The current newsletter goes to more than 255 recipients.

4) Annually the association has organized a Meeting of Members with presentations by various speakers. The last two annual membership meetings has seen more than 100 attendees. The cost has been a net of zero to the association. In addition to the Annual Meeting, CLIC has sponsored several lakes-wide lake-associated activities open to the public at large and at no charge to the public.

5) The association established and hosted many public meetings with Maine Division of Inland Fish and Wildlife Biologists and Game Wardens and annually since 1999 has organized and hosted an early spring supper meeting at which state, provincial and local fish and wildlife officials (biologists, wardens and department supervisors were able to inform and be informed about the concerns of the association’s members, guests and other community members. The dinner attendance fees that have been charged recently were intended to net the association zero surplus. Early events were paid for by the association.

6) Association members have assisted with the stocking of landlocked salmon in the waters of East Grand Lake and North Lake by Maine biologists. It provided boats and manpower to transfer the young fish to various locations on the lakes. All assistance was volunteered at no cost to the association.

7) The association has acted in a “watchdog” fashion monitoring the initial actions of a fledgeling gold mining operation on the Canadian side of the border in the immediate area of Monument Brook which is the main feeder stream to the first of the Chiputneticook Lakes. Two association member pilots overflew the mining area and others visited the site. The association officers initiated some significant correspondence with the officials of the mining company. (At this time all mining operations in the area have ceased.) There was no cost to the association.

8) An association committee oversees and collects data from approximately 15 trained Water Quality Observers who individually assess water quality and clarity at nearly 20 locations in our five lakes on a bi-weekly basis throughout the summer and fall. The data is shared three times a year with the St. Croix International Waterway Commission and the Maine Lakes Volunteer Oversight Commission.

9) Starting in the spring of 2002, the association has sponsored several pages on a small Web Site (see: <http://www.chiplakenews.org/CLIChome.htm> et al)

10) In 2001, the association mailed more than 350 letters inviting non-member landowners to JOIN CLIC. Those names and addresses have been entered to a database for possible later contact. The gathering of these names and entering to the database was all done voluntarily. Additional names and solicitations to JOIN CLIC Inc. is anticipated.

11) The association purchased and erected two large public bulletin boards at central locations in the lakes area. CLIC, Inc. has erected a third recently and is planning additional bulletin boards in the area of the Chiputneticooks. The cost of the initial bulletin boards was approximately $450.00 each. A carpenter was hired to build and CLIC members have installed them.

12) The association purchased and provided ten picnic tables to be placed on picnic beaches in various locations on East Grand Lake in 1999. The cost of the picnic tables was approximately $600.00 and the distribution to the various sites was volunteer. The tables are evaluated each summer and relocated and repaired as necessary.

Line 2: As is reflected in our attached short financial report, currently (and for the anticipated future) our sources of income are via:

1) Basic Membership Dues;
2) Membership Contributions over and above the basic membership dues;
3) Unsolicited Memorial Contributions;
4) Interest and Dividends accrued on bank accounts
5) Net/Net Income/Expense Activities

At this time no other source of support is truly anticipated although we will continue to generate funds from the first two sources mentioned above. The association’s annual gross income from members has averaged in the vicinity of just under $5000.00 over the last four years which we believe will continue without significant change.

We anticipate the probability of additional Memorial Gifts in the future and we may apply for grant(s) to fund specific future projects and activities. Bequests and small endowments are also a possibility as the word of our corporate (and exempt) existence becomes known. Although no specific project has been identified at the present time, the application for grants to fund specific projects is not beyond what CLIC, Inc. may attempt in the future.

We do not anticipate hiring the services of a professional fund-raiser.

Line 3: For the past four years, CLIC the association, has solicited and tracked dues payments from members but has not had a formal a fund-raising committee, nor has it conducted any “fund-raising events.” Prior to the last four years, no formal dues solicitation was made and few records of the actual contributions and dues receipts were kept. Many “members” went several years between contributions.

In the past the association has received a basic membership dues payment and in many cases, an unsolicited contribution from many members. Many members annually send a contribution of more than the basic required dues and some send substantially more. It has six recognized LIFE MEMBERS. All contributors became recognized members and are “billed” the following year for a basic ($10.00) membership fee. All additional payments are voluntary.

CLIC, Inc. was recently the recipient of several Memorial Contributions that were recommended by the families of deceased members (as reflected in the financial data, enclosed). These Memorial Contributions are the first ever received by CLIC.

Minor additional resources have resulted from surpluses realized from sponsored dinners and the sale of hats and T-shirts. All sponsored events and sales programs have been priced with the intent of breaking even, i.e., with no cost to the association. Early annual meetings were provided at no cost to those members (and guests) who attended but the association has recently made a net charge for all dinner events.

As previously mentioned CLIC, Inc. has named the chair of an Endowment, Bequests and Grants Committee but does not have any plans to engage professional fund-raisers.

A copy of the Information Brochure, 2002 Dues Billing Letter and Membership Data Form is attached. (The letter is dated currently as it is produced from a computer that uses the current date. Original solicitations for dues went out shortly after incorporation.)

Line 4a: Directors and Officers (no trustees)

Dir. & President: Deborah Hannigan, 12 Summer Street, Pittsfield, ME 04967
Dir. & Vice Pres. Jerry Wilson, 284Smyrna Street, Houlton, ME 04730
Dir. & Treasurer Anson Taber, 2 Ridgeway Street, Houlton, ME 04730
Dir. & Clerk/Sec. Robert Benn, RR#1-Box 134D, Weston, ME 04424
Director John Daigle Grey ME 04
Director Donald Ellis, 4 Madigan Street, Houlton, ME 04730
Director Thomas Kinney, 35 Kinney Lane, Fosterville, NB Canada E6H 2N9
Director & Comm. Kathie Stubbs
Director Betty Roberts, HC 81 - Box 125, Forest City-Brookton, ME 04413
Director Robert Ellis, 40 Court Street, Houlton, ME 04730
Director Ann Barnes Houlton, ME 04730
Membership William P. Walton, III, P. O. Box 4, Orient, ME 04471-0004

Line 4b: Annual Compensation of each: $0.00 No compensation is paid.
Line 4c: Do any serve by reason of being public officials or appointed by public officials? NO
Line 4d: Are any “disqualified persons” or have a business or family relationship with a disqualified person? NO

Line 5: Does the organization control or is it controlled by any other organization? NO
Is the organization an outgrowth or successor to another organization? YES As described previously, CLIC (the association) was formed in 1992/3 and has acted as an unincorporated association of members with a different EIN until this corporation was formed several months ago. The association will cease operation when all administrative details of the corporation have been completed.

Line 6: Will the organization engage in any of (the listed) transactions? NO

Line 7: Is the organization financially accountable to another organization? NO

Form 1023, Part II, Page 4:

Line 8: What assets does the organization have that are to be used in the performance of its exempt function N/A

Line 9: Will the organization be the beneficiary of tax-exempt fond financing? NO

Line 10a: Will any facilities or operations be managed by another organization or individual? NO

10b: Is the organization party to any leases? NO

Line 11: Is the organization a membership organization? YES

11a: Membership Requirements and Fees: Any person may become a member if he/she desires to affiliate with us and if he/she pays a $10.00 annual membership fee.

11b: Organization’s present and proposed efforts to attract members. CLIC, Inc. has assumed the membership of CLIC, the association. Additional methods are word of mouth, community actions, World Wide Web pages and anticipated selective mailings to lakefront property owners.

11c: What benefits are provided in exchange for payment of dues? Members are eligible to participate in all educational activities sponsored by the corporation and may request lake-associated assistance from the Board of Directors. Other than a quarterly informative newsletter, CLIC, Inc. will provide no product or service exclusively to members.

Line 12a: If the organization provides benefits, services or products, will members be required to pay for them? YES CLIC, Inc. will not “provide” any specific service or product.
It does sponsor several “dinner meetings” (educational) which all
participants must pay to attend and it may purchase and sell logo hats and T-shirts at cost.
All other benefits are “without charge” to both members and the general
public.

12b: Will the organization limit benefits to classes of individuals? NO

Line 13: Does or will the organization attempt to influence legislation? NO. CLIC, Inc. will not initiate contact with the general public, although it will monitor legislative action as it affects the Chiputneticook Lakes area and it may pay expenses of its representatives to associated meetings. The representative’s time will not be compensated.

Line 14: Will the organization intervene in any political campaigns or publish or distribute statements? NO

Part III: Page 5 Technical Requirements

Line 1: Are you filing this Form 1023 within 15 months from the end of the month in which your organization was created or formed?YES

LEAVE THE REMAINDER OF THIS PAGE BLANK - Lines 2-5

Part III, Page 6:

Line 7: Is the organization a private foundation?NO

Line 8: LEAVE BLANK

Line 9: Indicate the public charity classification the organization is requesting.

i) Section 509 (a) (2) As normally receiving: Not more than 1/3 of our support from gross investment income and more than 1/3 of our support from Contributions, membership fees and fees from exempt activities
SEE ADDENDUM, BELOW.

Part III, Page 7:

Line 10: If you checked i) on Line 9, has the organization completed a tax year? NO

We request an advance ruling and will attach two Form 872-C

Line 11: CLIC, Inc. will receive all the funds of the predecessor organization. The amount of these funds are substantial ($5,000 to $10,000) but the exact amount has not been determined at this time and no funds of that organization have been received at this time.

Line 12: LEAVE BLANK

Line 13: LEAVE BLANK

Line 14: Indicate if your organization is one of the following:
Church NO
School NO
Hospital NO
509a3 NO
Pvt. Fdn NO
Home/Aged NO
Child Care NO
Scholarship NO
Takeover NO

Part IV, Page 8: Financial Data

Current Tax Year: From 4/9/02 to 12/31/02

PERIOD OF THIS REPORT: APRIL 9, 2002 to Sept 27, 2002

REVENUE

1. Gifts Grants & Contributions 0.00
2. Membership Fees
1021/2 2002 Dues 5653.40
1031/2 Prepaid 2003 Dues 190.00
1041 Prepaid 2004 Dues 30.00
1051 Prepaid 2005 Dues 10.00 5883.40
3. Gross Investment Income 0.00
4. Net from Unrelated Business Activities 0.00
5. Tax Revenues Levied and Paid or Spent 0.00
6. Value of Services Furnished by Government 0.00
7. Other Income
1023 Madigan Memorials 680.00
1028 Misc. Memorials (Wilson) 25.00 705.00
8: Subtotal 5428.00
9. Gross Receipts from Admissions & Sales
2021 Fisheries Dinner 468.00
10. Subtotal 5896.00
11. Sale of Capital Assets 0.00
12. Unusual Grants Received 0.00
13. TOTAL REVENUE 7056.40

EXPENSES

14. Fund-raising 0.00
15. Contributions, Gifts & Grants Paid 0.00
16. Disbursements to or for Members 0.00
17. Compensation of Officers, Dir. and Trustees 0.00
18. Salaries and Wages 0.00
19. Interest Expense 0.00
20. Occupancy and Rent 0.00
21. Depreciation and Depletion 0.00
22. Other Expenses
4023 Membership (Dues Notices & Development) -314.32
4024 Legal Services -600.00
7021 Fisheries Dinner -546.00
7029 Community Bulletin Board Erected -400.00
23. TOTAL EXPENSES -1860.32
24. EXCESS OF REVENUE OVER EXPENSES 5196.08

Part IV, Page 8: Financial Data COLUMN 2

PROPOSED BUDGET: 2003

REVENUE

1. Gifts Grants & Contributions 0.00
2. Membership Fees
1031 2003 Dues 6000.00
1041 Prepaid 2004 Dues 30.00
1051 Prepaid 2005 Dues 10.00 6040.00
3. Gross Investment Income 0.00
4. Net from Unrelated Business Activities 0.00
5. Tax Revenues Levied and Paid or Spent 0.00
6. Value of Services Furnished by Government 0.00
7. Other Income
2038 Interest on Bank Deposits 80.00
1038 Misc. Memorials 1000.00 1080.00
8: Subtotal 7120.00
9. Gross Receipts from Admissions & Sales
2031 Fisheries Dinner 550.00
2032 Annual Meeting Dinner 1000.00
2039 Sales of Shirts and Hats 500.00
10. Subtotal 9170.00
11. Sale of Capital Assets 0.00
12. Unusual Grants Received 0.00
13. TOTAL REVENUE 9170.00

EXPENSES

14. Fund-raising 0.00
15. Contributions, Gifts & Grants Paid -3500.00
16. Disbursements to or for Members 0.00
17. Compensation of Officers, Directors and Trustees 0.00
18. Salaries and Wages 0.00
19. Interest Expense 0.00
20. Occupancy and Rent 0.00
21. Depreciation and Depletion 0.00
22. Other Expenses
4031 Board of Director Meetings -100.00
4032 Insurance -250.00
4033 Membership Development -450.00
4034 Accounting Service -400.00
4038 Newsletter Expense -500.00
4039 Misc. Administration Expense -250.00
7031 Fisheries Dinner -550.00
7032 Annual Meeting Dinner -1000.00
7039 Local Projects -1000.00
9030 Committee Expenses -400.00
9037 WWW Site -100.00
9038 Misc. Expenses -160.00
9039 Goods Purchased for Sale -500.00 -5660.00
23. TOTAL EXPENSES -9160.00
24. EXCESS OF REVENUE OVER EXPENSES 0.00

Part IV, Page 8: Financial Data COLUMN 3

PROPOSED BUDGET: 2004

REVENUE

1. Gifts Grants & Contributions 0.00
2. Membership Fees
1041 2004 Dues 6500.00
1051 Prepaid 2005 Dues 10.00 6510.00
3. Gross Investment Income 0.00
4. Net from Unrelated Business Activities 0.00
5. Tax Revenues Levied and Paid or Spent 0.00
6. Value of Services Furnished by Government 0.00
7. Other Income
2048 Interest on Bank Deposits 80.00
1048 Misc. Memorials 1500.00 1580.00
8: Subtotal 8090.00
9. Gross Receipts from Admissions & Sales
2041 Fisheries Dinner 550.00
2042 Annual Meeting Dinner 1000.00
2049 Sales of Shirts and Hats 500.00
10. Subtotal 10140.00
11. Sale of Capital Assets 0.00
12. Unusual Grants Received 0.00
13. TOTAL REVENUE 10140.00

EXPENSES

14. Fund-raising 0.00
15. Contributions, Gifts & Grants Paid -3500.00
16. Disbursements to or for Members 0.00
17. Compensation of Officers, Directors and Trustees 0.00
18. Salaries and Wages 0.00
19. Interest Expense 0.00
20. Occupancy and Rent 0.00
21. Depreciation and Depletion 0.00
22. Other Expenses
4041 Board of Director Meetings -100.00
4042 Insurance -250.00
4043 Membership Development -640.00
4044 Accounting Service -400.00
4048 Newsletter Expense -500.00
4049 Misc. Administration Expense -250.00
7041 Fisheries Dinner -550.00
7042 Annual Meeting Dinner -1000.00
7049 Local Projects -1800.00
9040 Committee Expenses -400.00
9047 WWW Site -100.00
9048 Misc. Expenses -150.00
9049 Goods Purchased for Sale -500.00 -6640.00

23. TOTAL EXPENSES -10140.00

24. EXCESS OF REVENUE OVER EXPENSES 0.00

Part IV: Financial Data

B Balance Sheet Net Worth for the period April 9, 2002 to Sept 27, 2002

Assets

1. Cash 5196.08
2. Accounts Receivable 0.00
3. Inventories 0.00
4. Bonds and Notes 0.00
5. Corporate Stocks 0.00
6. Mortgage Loans 0.00
7. Other Investments 0.00
8. Depreciable and depletable assets 0.00
9. Land 0.00
10. Other Assets 0.00
11. Total Assets 5196.08

Liabilities

12. Accounts Payable 0.00
13. Contributions, Gifts and Grants Payable 0.00
14. Mortgages and Notes Payable 0.00
15. Other Liabilities 0.00
16. Total Liabilities 0.00
17. Total Fund Balances or Net Assets 0.00
18. Total Liabilities and net assets 5196.08

LEAVE BOX AT LOWER RIGHT OF PAGE BLANK


Addendum to Original Application Form 1023

Mr. L. Wayne Bothe ID #31-07645
Exempt Organizations Specialist
Department of the Treasury
P. O. Box 2508 - Room 4106
Cincinnati, Ohio 45201

VOICE 513 - 263-3491
FAX 513 - 263-3669

Chiputneticook Lakes International Conservancy - Application for Recognition of Tax Exemption

ADDENDUM TO APPLICATION FORM 1023

Statement regarding Distributions

With regard to the distribution of the funds of the Chiputneticook Lake International Conservancy, Inc.:

The Chiputneticook Lake International Conservancy, Inc. will only distribute funds to organizations which are exempt under section 501 (c) (3), and in cases where the recipient organization is not exempt under section 501 (c) (3), we will procure and keep on file written evidence that any funds so distributed will remain dedicated to the required purposes and that the recipient will use our funds for those purposes only.

Signed ______________________________ January (@23) 2003
Debra Hannigan, President

CHANGE TO APPLICATION FORM 1023

Part III, Page 6:

Line 9: Indicate the public charity classification the organization is requesting.

h) Section 509 (a) (1) and 170 (b) (1) (A) (vi)

As receiving a substancial part of its support in the form of contributions from publicly supported organizations, from a governmental unit or from the general public.

A substantial amount of our income is expected to come from member dues (which are essentially contributions since nothing of substancial value is received in return) and contributions.

Change authorized by:

______________________________ January (@23) 2003
Debra Hannigan, President

______________________________ January 21, 2003
William P. Walton, III - Correspondent


NOTE: In our original application, we mistakenly indicated option (i)
We are NOT primarily supported by fundraising activities in which we sell various items, receive income from admissions, sales of merchandise or services or furnish facilities. i) Section 509 (a) (2) As normally receiving: Not more than 1/3 of our support from gross investment income and More than 1/3 of our support from Contributions, membership fees and fees from exempt activities

A copy of the original Page 6 of our Form 1023 is attached with the appropriate change, initial of authorization and date.

ADDITIONAL PAYMENT RE: APPLICATION FORM 1023

USER FEE: Payment made previously: $ 150.00

Additional payment (Attached herewith) 350.00

Total Payment: $500.00



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