FORM 1023-EZ for TAHOE BLUE VOLLEYBALL CLUB

Field Data
EIN 81-4687805
Case Number EO-2017067-000739
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TAHOE BLUE VOLLEYBALL CLUB
Organization’s Mailing Address PO BOX 550632
City SOUTH LAKE TAHOE
State CA
ZIP 96155
Accounting period End 12
Primary contact name KELLY RACCA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY RACCA
DIRECTOR
1852 NARRAGANSETT CIR
SOUTH LAKE TAHOE CA 96150-5288

Officer/Director/Trustee Two

KIMBERLY PEVENAGE
SECRETARY/TREASURER
2187 CATALINA DR
SOUTH LAKE TAHOE CA 96150-5288

Officer/Director/Trustee Three

MEGAN GOLDBERG
MEMBER AT LARGE
1425 SEMINOLE WAY
SOUTH LAKE TAHOE CA 96150-5288

Organization’s website
Organization’s email TAHOEBLUEVBC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N40 - Sports Training Facilities, Agencies
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 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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