FORM 1023-EZ for PANTHERS BOOSTER CLUB

Field Data
EIN 46-0969344
Case Number EO-2014295-000301
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PANTHERS BOOSTER CLUB
Organization’s Mailing Address 14642 KRYPTON ST NW
City RAMSEY
State MN
ZIP 55303-5626
Accounting period End 12
Primary contact name KATHRYN WALDERA-DEROSA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TINA STONE
PRESIDENT
14642 KRYPTON ST NW
RAMSEY MN 55303-5626

Officer/Director/Trustee Two

KATHRYN WALDERA-DEROSA
VICE-PRESIDENT
14404 IODINE ST NW
RAMSEY MN 55303-4726

Officer/Director/Trustee Three

CHRISTINE ERNTSON
SECRETARY
9717 UPTON AVE N
BROOKLYN PARK MN 55444-1013

Officer/Director/Trustee Four

PATRICIA ERICKSON
TREASURER
2114 150TH LN NW
ANDOVER MN 55304-6416

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/5/2012
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
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 No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
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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