FORM 1023-EZ for BALSAM LAKE BASSMASTERS INC

Field Data
EIN 82-2511716
Case Number EO-2017251-000481
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BALSAM LAKE BASSMASTERS INC
Organization’s Mailing Address PO BOX 134
City BALSAM LAKE
State WI
ZIP 54810
Accounting period End 12
Primary contact name MODESTY MONTEMAYOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MODESTY MONTEMAYOR
DIRECTOR/SECRETARY TREASURER
PO BOX 134
BALSAM LAKE WI 54810

Officer/Director/Trustee Two

FRANK MONTEMAYOR
DIRECTOR/VICE PRESIDENT
PO BOX 134
BALSAM LAKE WI 54810

Officer/Director/Trustee Three

WAYNE ANKRUM
DIRECTOR/PRESIDENT
1673 175TH AVENUE
CENTURIA WI 54824

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/2017
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O30 - Adult, Child Matching Programs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 Yes
One Third Support Gifts No
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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