FORM 1023-EZ for MOSS BLUFF YOUTH BASKETBALL

Field Data
EIN 81-4186230
Case Number EO-2017009-000324
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOSS BLUFF YOUTH BASKETBALL
Organization’s Mailing Address 1180 DON MANUEL BLVD
City LAKE CHARLES
State LA
ZIP 70611
Accounting period End 10
Primary contact name AMBER EWING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMBER EWING
TREASURER
463 BARBARA HILL DR
RAGLEY LA 70657

Officer/Director/Trustee Two

COREY BELLARD
PRESIDENT
1833 N MICHAEL SQ
LAKE CHARLES LA 70611

Officer/Director/Trustee Three

CHAD SMITH
VICE-PRESIDENT
1164 RUE BROOKLYN
LAKE CHARLES LA 70611

Officer/Director/Trustee Four

BUCK LIVINGSTON
SECRETARY
458 KOONCE RD
LAKE CHARLES LA 70611

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/20/2016
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N62 - Basketball
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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