FORM 1023-EZ for BLOOMFIELD SOCCER CLUB

Field Data
EIN 75-3228808
Case Number EO-2019030-000239
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLOOMFIELD SOCCER CLUB
Organization’s Mailing Address PO BOX 536
City BLOOMFIELD
State NY
ZIP 14469-536
Accounting period End 12
Primary contact name EJ WARDEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICIA CONKLIN
TREASURER
55 MAIN STREET
BLOOMFIELD NY 14469

Officer/Director/Trustee Two

EJ WARDEN
DIRECTOR
14 PAGE PLACE
BLOOMFIELD NY 14469

Officer/Director/Trustee Three

SARAH KACHMARYK
REGISTRAR
POND ROAD
BLOOMFIELD NY 14469

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/07
Organization Incorporation State NY
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: 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name EJ WARDEN
Signature Title DIRECTOR
Signature Date 12/21/18

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