FORM 1023-EZ for PEACE HOCKEY

Field Data
EIN 81-2305369
Case Number EO-2019196-000342
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PEACE HOCKEY
Organization’s Mailing Address 2833 MONTICELLO DRIVE
City WINSTON SALEM
State NC
ZIP 27106
Accounting period End 12
Primary contact name DELENA CICUTO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA MARTIN
PRESIDENT
2833 MONTICELLO DRDIVE
WINSTON SALEM NC 27106

Officer/Director/Trustee Two

STEPHANIE FLORES DA VALGAZ
VICE PRESIDENT
1936 GASTON STREET
WINSTON SALEM NC 27103

Officer/Director/Trustee Three

DELENA CICUTO
SECRETARY & TREASURE
6004 SARAHCREEK COURT
RALEIGH NC 27607

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/11/16
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: Yes
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 DELENA CICUTO
Signature Title SECRETARY & TREASURE
Signature Date 7/12/19

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