FORM 1023-EZ for ALTUS 12TH MAN CLUB

Field Data
EIN 47-1893014
Case Number EO-2015104-000046
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ALTUS 12TH MAN CLUB
Organization’s Mailing Address PO BOX 9001
City ALTUS
State OK
ZIP 73522
Accounting period End 12
Primary contact name DIANE BEACH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KEVIN MARPLE
PRESIDENT
1425 N HUDSON
ALTUS OK 73521

Officer/Director/Trustee Two

DIANE BEACH
TREASURER
20164 ECR 175
ELMER OK 73539

Officer/Director/Trustee Three

BRIAN BUSH
VICE PRESIDENT
3705 PILGRIM LN
ALTUS OK 73521

Officer/Director/Trustee Four

SOLVAY FELLER
SECRETARY
613 TAFT
ALTUS OK 73521

Officer/Director/Trustee Five

JENNIFER WILSON
BOARD MEMBER
15686 SCR 205
BLAIR OK 73526

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/10/2015
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, 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
Signature Title
Signature Date

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