FORM 1023-EZ for ST CROIX VALLEY QUARTER MIDGET ASSOCIATION

Field Data
EIN 46-5228699
Case Number EO-2014351-000089
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ST CROIX VALLEY QUARTER MIDGET ASSOCIATION
Organization’s Mailing Address 1677 87TH ST
City NEW RICHMOND
State WI
ZIP 54017
Accounting period End 12
Primary contact name DAVID S MADSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID MADSEN
PRESIDENT
821 5TH AVE N
BAYPORT MN 55003

Officer/Director/Trustee Two

JIM MOE
VICE PRESIDENT
1254 217TH AVE
NEW RICHMOND WI 54017

Officer/Director/Trustee Three

SHAWN KELLEY
TREASURER
1677 87TH ST
NEW RICHMOND WI 54017

Officer/Director/Trustee Four

HEIDI KELLEY
SECRETARY
1677 87TH ST
NEW RICHMOND WI 54017

Organization’s website WWW.SCVQMA.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/2014
Organization Incorporation State WI
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 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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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