FORM 1023-EZ for CCSD FIRST ROBOTICS BOOSTER CLUB

Field Data
EIN 47-5287848
Case Number EO-2015314-000286
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CCSD FIRST ROBOTICS BOOSTER CLUB
Organization’s Mailing Address 124 6TH AVENUE
City DEWITT
State IA
ZIP 52742-1056
Accounting period End 12
Primary contact name JIM LASS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JODI PROSISE
PRESIDENT
124 6TH AVENUE
DEWITT IA 52742

Officer/Director/Trustee Two

WADE BURKEN
VICE PRESIDENT
242 11TH CIRCLE
DEWITT IA 52742

Officer/Director/Trustee Three

JIM LASS
OFFICER / GRANTS COORDINATOR
2311 15TH ST CT
DEWITT IA 52742-1056

Officer/Director/Trustee Four

JULIE BURKEN
TREASURER
242 11TH CIRCLE
DEWITT IA 52742

Officer/Director/Trustee Five

LINDA HLEDIK
SECRETARY
1304 MAPLEWOOD COURT
DEWITT IA 52742

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/3/2015
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
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
Signature Title
Signature Date

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