FORM 1023-EZ for NORTHFIELD BOOSTER CLUB

Field Data
EIN 46-5650710
Case Number EO-2015169-000218
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTHFIELD BOOSTER CLUB
Organization’s Mailing Address N10752 SCHOOL HOUSE STE 2
City HIXTON
State WI
ZIP 54635-8416
Accounting period End 1
Primary contact name GERALD JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GERALD JOHNSON
PRESIDENT
N10651 DEGROOT RD
HIXTON WI 54635

Officer/Director/Trustee Two

RANDY BURNETT
VICE PRESIDENT
N10060 N BRANCH RD
HIXTON WI 54635

Officer/Director/Trustee Three

AMY MARTIN
TREASURER
N10060 N BRANCH RD
HIXTON WI 54635

Officer/Director/Trustee Four

DONNA BERGERSON
SECRETARY
W15766 STATE HWY 121
HIXTON WI 54635

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/9/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 Yes
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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