FORM 1023-EZ for 86466 MONUMENT VALLEY USBC

Field Data
EIN 74-3162132
Case Number EO-2016029-000266
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 86466 MONUMENT VALLEY USBC
Organization’s Mailing Address 540 4TH ST / PO BOX 75
City GERING
State NE
ZIP 69341
Accounting period End 8
Primary contact name LAURIE HAUSER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LAURIE HAUSER
ASSOICATION MANAGER
540 4TH ST / PO BOX 75
GERING NE 69341

Officer/Director/Trustee Two

JIM WALKER
PRESIDENT
1255 N ST
GERING NE 69341

Officer/Director/Trustee Three

JAN BAYNE
VICE-PRESIDENT
180300 FARMSTEAD ROAD
SCOTTSBLUFF NE 69361

Officer/Director/Trustee Four

JAY WEITZEL
DIRECTOR
240364 KARUBOS RD
SCOTTSBLUFF NE 69361

Officer/Director/Trustee Five

RAMONA GILES
DIRECTOR
1815 P ST
GERING NE 69341

Organization’s website
Organization’s email MARINEMOM20@HOTMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/14/2015
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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