FORM 1023-EZ for CONCH REPUBLIC WRESTLING CLUB INC

Field Data
EIN 47-1090373
Case Number EO-2015106-000241
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CONCH REPUBLIC WRESTLING CLUB INC
Organization’s Mailing Address PO BOX 5406
City KEY WEST
State FL
ZIP 33045
Accounting period End 12
Primary contact name CHAZ JIMENEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

OSBALDO HERNANDEZ
PRESIDENT
1262B MATTHEW PERRY RD
KEY WEST FL 33040

Officer/Director/Trustee Two

JOHN MOELLER
TREASURER
1616 TRINIDAD DR
KEY WEST FL 33040

Officer/Director/Trustee Three

CHAZ JIMENEZ
VICE PRESIDENT
19453 SEMINOLE ST
SUGARLOAF KEY FL 33042

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/4/2014
Organization Incorporation State FL
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: Yes
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 Yes
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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