FORM 1023-EZ for KAJUKENBO ASSOCIATION OF AMERICA GAYLORD METHOD

Field Data
EIN 84-4520994
Case Number EO-2020049-000440
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KAJUKENBO ASSOCIATION OF AMERICA GAYLORD METHOD
Organization’s Mailing Address 4512 OCEAN LANE
City ELK GROVE
State CA
ZIP 95757
Accounting period End 12
Primary contact name KELLY GAYLORD MCCORMICK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY MCCORMICK
PRESIDENT
4512 OCEAN LN
ELK GROVE CA 95757

Officer/Director/Trustee Two

TIMOTHY GAGNIER
VICE PRESIDENT
15005 NE YAMHILL ROAD
YAMHILL OR 97148

Officer/Director/Trustee Three

LYNN CASE
SECRETARY
2545 MARILYN STREET
POCATELLO ID 83201

Officer/Director/Trustee Four

NICOLAS WILLIAMS
TREASURER
15764 VIA TERESA
SAN LORENZO CA 94580

Officer/Director/Trustee Five

ERIC COLEMAN
WEB MASTER
2811 LA FRONTERA BLVD - 223
AUSTIN TX 78728

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States Yes
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 KELLY MCCORMICK
Signature Title PRESIDENT
Signature Date 2/14/2020

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