FORM 1023-EZ for BACK MOUNTAIN YOUTH LACROSSE INC

Field Data
EIN 61-1523793
Case Number EO-2015026-000113
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BACK MOUNTAIN YOUTH LACROSSE INC
Organization’s Mailing Address PO BOX 1746
City SHAVERTOWN
State PA
ZIP 18708
Accounting period End 9
Primary contact name JAY S MEYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK LEO
PRESIDENT
129 BIRCH STREET
DALLAS PA 18612

Officer/Director/Trustee Two

SUSAN DIANA
VICE PRESIDENT
25 EAST LEDGE LANE
DALLAS PA 18612

Officer/Director/Trustee Four

MICKEY BUTTON
SECRETARY
72 OLIVER ROAD
SWEET VALLEY PA 18656

Officer/Director/Trustee Five

JAY MEYER
TREASURER
29 FARMVIEW DRIVE
WYOMING PA 18644

Organization’s website WWW.BMYLAX.COM
Organization’s email BMTLAX@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/2007
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
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 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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