FORM 1023-EZ for ZEN MARTIAL ARTS BOOSTER CLUB

Field Data
EIN 82-2346114
Case Number EO-2021076-000402
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ZEN MARTIAL ARTS BOOSTER CLUB
Organization’s Mailing Address 207 N WELLS ST
City EDNA
State TX
ZIP 77957
Accounting period End 12
Primary contact name SAM MATLOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SAM MATLOCK
PRESIDENT, DIRECTOR
602 N WELLS ST
EDNA TX 77957

Officer/Director/Trustee Two

DUNAYA MASON
TREASURER, DIRECTOR
9112 FM 1593
LOLITA TX 77971

Officer/Director/Trustee Three

AMBER BOZKA
SECRETARY, DIRECTOR
11593 FM 530
HALLETTSVILLE TX 77964

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/2020
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 SAM MATLOCK
Signature Title PRESIDENT, DIRECTOR
Signature Date 1/18/2021

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