FORM 1023-EZ for CENTREVILLE ROBOTICS BOOSTER CLUB

Field Data
EIN 47-5236422
Case Number EO-2019259-000985
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CENTREVILLE ROBOTICS BOOSTER CLUB
Organization’s Mailing Address 5746 UNION MILL RD BOX 559
City CLIFTON
State VA
ZIP 20124-1128
Accounting period End 6
Primary contact name SUSAN MITCHELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTHONY BERTOGLIO
PRESIDENT
14502 MEETING CAMP ROAD
CENTREVILLE VA 20121

Officer/Director/Trustee Two

NANCY HOLINCHECK
VICE PRESIDENT
14722 PICKETS POST ROAD
CENTREVILLE VA 20121

Officer/Director/Trustee Three

DEBORAH PURCHASE-NELSON
SECRETARY
6401 STONEHAVEN COURT
CLIFTON VA 20124

Officer/Director/Trustee Four

SUSAN MITCHELL
TREASURER
10016 LATIMER COURT
FAIRFAX VA 22032

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/5/15
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SUSAN MITCHELL
Signature Title TREASURER
Signature Date 9/13/19
EIN 47-5236422
Case Number EO-2015281-000303
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTREVILLE ROBOTICS BOOSTER CLUB INC
Organization’s Mailing Address 6001 UNION MILL ROAD
City CLIFTON
State VA
ZIP 20124
Accounting period End 6
Primary contact name SUSAN ZIMMERMANN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NANCY HOLINCHECK
PRESIDENT
14722 PICKETS POST ROAD
CENTREVILLE VA 20121

Officer/Director/Trustee Two

ANTHONY BERTOGLIO
VICE PRESIDENT
14502 MEETING CAMP ROAD
CENTREVILLE VA 20121

Officer/Director/Trustee Three

GAYNA SMITH
SECRETARY
5605 PICKWICK ROAD
CENTREVILLE VA 20121

Officer/Director/Trustee Four

SUSAN ZIMMERMANN
TREASURER
6409 DEEPWOOD FARM DRIVE
CLIFTON VA 20124

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/5/2015
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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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