FORM 1023-EZ for CALIFORNIA BLASTERS VOLLEYBALL CLUB

Field Data
EIN 83-4075091
Case Number EO-2019128-000250
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CALIFORNIA BLASTERS VOLLEYBALL CLUB
Organization’s Mailing Address 3820 NATHAN WAY
City PALO ALTO
State CA
ZIP 94303
Accounting period End 12
Primary contact name ANTONY PUTHANPURAYIL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTONY PUTHANPURAYIL
PRESIDENT
3820
PALO ALTO CA 94303

Officer/Director/Trustee Two

PREMA THEKEK
CHAIRPERSON
151 SMITH DR
ALAMO CA 94507

Officer/Director/Trustee Three

RAJU VARGHESE
SECRETARY
1823 CAPE HATTERAS WAY
SAN JOSE CA 95133

Officer/Director/Trustee Four

TOMMY PAZHEMPALLIL
JOINT SECRETARY
5680 CARTTELYA DR
SAN RAMON CA 94582

Officer/Director/Trustee Five

JOSEKUTTY JOSE
TREASURER
4273 THE MASTERS DR
FAIRFIELD CA 94533

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/4/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ANTONY PUTHANPURAYIL
Signature Title PRESIDENT
Signature Date 5/6/19

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