FORM 1023-EZ for WOLFPACK ROLLER DERBY

Field Data
EIN 81-0880264
Case Number EO-2016165-000312
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WOLFPACK ROLLER DERBY
Organization’s Mailing Address PO BOX 283
City GREYBULL
State WY
ZIP 82426
Accounting period End 12
Primary contact name DAGNY REVILLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RACHEL WADE
PRESIDENT
532 3RD AVE N
GREYBULL WY 82426

Officer/Director/Trustee Two

CHANCIE WAMHOFF
VICE PRESIDENT
929 E SOUTH STREET
POWELL WY 82435

Officer/Director/Trustee Three

ANNA GIL
SECRETARY
1305 29TH STREET
CODY WY 82414

Officer/Director/Trustee Four

DAGNY REVILLA
TREASURER
1113 31ST STREET
CODY WY 82414

Organization’s website
Organization’s email WOLFPACKROLLERDERBY@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2015
Organization Incorporation State WY
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 No
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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