FORM 1023-EZ for REBEL DIVING CLUB

Field Data
EIN 81-4960766
Case Number EO-2017061-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REBEL DIVING CLUB
Organization’s Mailing Address 205 N STEPANIE ST SUITE D255
City HENDERSON
State NV
ZIP 89074
Accounting period End 12
Primary contact name NATALIE GOULD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NATALIE GOULD
PRESIDENT
2545 GRASSY SPRING PLACE
LAS VEGAS NV 89135

Officer/Director/Trustee Two

MAQUEL HOULIHAN
TREASURER
2051 LOST PINES CIRCLE
HENDERSON NV 89074

Officer/Director/Trustee Three

MICHELLE EDMONDS
SECRETARY
1968 OAKWOOD STATION CT
HENDERSON NV 89012

Officer/Director/Trustee Four

LANDON MARZULLO
DIRECTOR/COACH
3811 FARENHEIT COURT
LAS VEGAS NV 89129

Officer/Director/Trustee Five

MICHAEL LEWARK
DIRECTOR/COACH
1501 SW 115TH AVE
DAVIE FL 33325

Organization’s website WWW.REBELDIVINGCLUB.COM
Organization’s email REBELDIVINGCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/12/2017
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N67 - Swimming, Water Recreation
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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