FORM 1023-EZ for MAYHEM ROLLER DERBY

Field Data
EIN 82-0871896
Case Number EO-2019143-000208
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAYHEM ROLLER DERBY
Organization’s Mailing Address PO BOX 12308
City LONGVIEW
State TX
ZIP 75607
Accounting period End 6
Primary contact name MICHELLE MCCANN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE MCCANN
BUSINESS MANAGER
323 FM 22 E
JACKSONVILLE TX 75766-6792

Officer/Director/Trustee Two

AMBER HUNT
LEAGUE DIRECTOR
1004 DONALD DRIVE
LONGVIEW TX 75604-5746

Officer/Director/Trustee Three

ASHLEY KILBY
SECRETARY
2402 RAMBLEWOOD DRIVE
HENDERSON TX 75652

Officer/Director/Trustee Four

PATTY WILLIAMS
TREASURER
3713 COLONY PARK
TYLER TX 75701-9603

Organization’s website HTTPS://WWW.TEXASMAYHEM.COM/
Organization’s email MADAMSOFMAYHEM@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/13/17
Organization Incorporation State TX
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: 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 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 MICHELLE MCCANN
Signature Title BUSINESS MANAGER
Signature Date 5/21/19

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