FORM 1023-EZ for BLACKWATER RUGBY INC

Field Data
EIN 47-3746270
Case Number EO-2015272-000361
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACKWATER RUGBY INC
Organization’s Mailing Address 4525 ALABAMA AVE
City LYNCHUBRG
State VA
ZIP 24502
Accounting period End 12
Primary contact name JOSHUA SUTTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOSHUA SUTTON
TREASURER
4525 ALABAMA AVE
LYNCHBURG VA 24502

Officer/Director/Trustee Two

DIEGO SILVA ACEITUNO
PRESIDENT
360 WILD TURKEY RD
LYNCHBURG VA 24502

Officer/Director/Trustee Three

ADAM EVANS
MATCH SECRETARY
128 WIGGINGTON RD
LYNCHBURG VA 24502

Officer/Director/Trustee Four

DANIELLE SILVA ACEITUNO
CLUB SECRETARY
360 WILD TURKEY RD
LYNCHBURG VA 24502

Organization’s website WWW.BLACKWATERRFC.COM
Organization’s email BLACKWATERRFC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/2015
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 Yes
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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