FORM 1023-EZ for AMES ROLLER DERBY ASSOCIATION

Field Data
EIN 47-2179042
Case Number EO-2015016-000018
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AMES ROLLER DERBY ASSOCIATION
Organization’s Mailing Address 1910 STEVENSON DR
City AMES
State IA
ZIP 50010-4321
Accounting period End 7
Primary contact name NICHOLE DUGAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NICHOLE DUGAN
PRESIDENT
1910 STEVENSON DR
AMES IA 50010-4321

Officer/Director/Trustee Two

KERI WAGNER
VICE PRESIDENT
2013 MELROSE AVE
AMES IA 50010

Officer/Director/Trustee Three

RITA MUGGENBERG
TREASURER
5415 CLEMENS BLVD
AMES IA 50014

Officer/Director/Trustee Four

JOLEEN HULSEBUS
SECRETARY
919 J AVE
NEVADA IA 50201

Organization’s website WWW.AMESRDA.COM
Organization’s email AMESRDA@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2014
Organization Incorporation State IA
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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