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        <AddressLine1>3511 SE Milwaukie Ave</AddressLine1>
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        <State>OR</State>
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      <Name>
        <BusinessNameLine1>Independent Order of Odd Fellows</BusinessNameLine1>
        <BusinessNameLine2>Peninsula Lodge 128</BusinessNameLine2>
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        <AddressLine1>4834 N LOMBARD STREET</AddressLine1>
        <City>PORTLAND</City>
        <State>OR</State>
        <ZIPCode>97203</ZIPCode>
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      <DateSigned>2012-05-22</DateSigned>
      <AuthorizeThirdParty>true</AuthorizeThirdParty>
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    <Preparer>
      <Name>Linda C Hanson</Name>
      <Phone>5032332177</Phone>
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    <TaxYear>2011</TaxYear>
    <BuildTS>2016-02-24 21:20:13Z</BuildTS>
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      <GrantsAndSimilarAmountsPaid>18604</GrantsAndSimilarAmountsPaid>
      <BenefitsPaidToOrForMembers>4058</BenefitsPaidToOrForMembers>
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