FORM 1023-EZ for PLATTE VALLEY MARTIAL ARTS

Field Data
EIN 83-2457553
Case Number EO-2018323-000480
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLATTE VALLEY MARTIAL ARTS
Organization’s Mailing Address PO BOX 1270
City SARATOGA
State WY
ZIP 82331
Accounting period End 12
Primary contact name NICHOLAS HADERLIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICHOLAS HADERLIE
DIRECTOR/PRESIDENT
PO BOX 1270
SARATOGA WY 82331

Officer/Director/Trustee Two

ROBERT KEEL
DIRECTOR/TREASURER
PO BOX 1270
SARATOGA WY 82331

Officer/Director/Trustee Three

CHRISTINA REYES
DIRECTOR/VICE PRESIDENT
PO BOX 1270
SARATOGA WY 82331

Officer/Director/Trustee Four

RACHEL SWANSON
DIRECTOR/SECRETARY
PO BOX 1270
SARATOGA WY 82331

Officer/Director/Trustee Five

TRENTON SWANSON
DIRECTOR
PO BOX 1270
SARATOGA WY 82331

Organization’s website
Organization’s email NHADERLIE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/2/18
Organization Incorporation State WY
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: Yes
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 NICHOLAS HADERLIE
Signature Title DIRECTOR/PRESIDENT
Signature Date 11/16/18

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