FORM 1023-EZ for GULF COAST ROLLER DERBY

Field Data
EIN 83-3884180
Case Number EO-2019137-000241
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GULF COAST ROLLER DERBY
Organization’s Mailing Address PO BOX 15531
City PANAMA CITY
State FL
ZIP 32406
Accounting period End 12
Primary contact name CHRISTINE OSTERTAG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTINE OSTERTAG
TREASURER
3023 CANAL AVENUE
PANAMA CITY FL 32405

Officer/Director/Trustee Two

CHRISTEN SEGAL
VICE PRESIDENT
110 TIERRA VERDE TRAIL
PANAMA CITY BEACH FL 32407

Officer/Director/Trustee Three

DUSTI BERARD
SECRETARY
169 BOCA LAGOON DRIVE
PANAMA CITY BEACH FL 32408

Organization’s website
Organization’s email SUGARSANDSROLLERDOLLS@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N80 - Professional Athletic Leagues
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 No
Correctness Declaration Yes
Signature Name CHRISTINE OSTERTAG
Signature Title TREASURER
Signature Date 5/15/19

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