FORM 1023-EZ for AMISTAD SOCCER CLUB

Field Data
EIN 84-2589250
Case Number EO-2019221-000057
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AMISTAD SOCCER CLUB
Organization’s Mailing Address 2710 HAINES AVE
City RAPID CITY
State SD
ZIP 57702
Accounting period End 12
Primary contact name AMY R SCULL LARSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NATHANIEL LARSON
PRESIDENT
3119 FLINT DR
RAPID CITY SD 57702

Officer/Director/Trustee Two

MILENE GRUBRIC
VICE PRESIDENT
2296080 CANDLELIGHT DR
RAPID CITY SD 57703

Officer/Director/Trustee Three

AMY SCULL LARSON
SECRETARY
3119 FLINT DR
RAPID CITY SD 57702

Officer/Director/Trustee Four

SHARI MANTURANO
MEMBER
1615 TERRACE PL
RAPID CITY SD 57701

Organization’s website HTTP://CLUBS.BLUESOMBRERO.COM/AMISTADSOCCERCLUB
Organization’s email AMISTADSOCCERCLUBSD@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/1/19
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 No
Correctness Declaration Yes
Signature Name AMY SCULL LARSON
Signature Title SECRETARY
Signature Date 8/7/19

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