FORM 1023-EZ for OLE BROOK FC SOCCER CLUB

Field Data
EIN 84-3026804
Case Number EO-2019317-000134
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OLE BROOK FC SOCCER CLUB
Organization’s Mailing Address PO BOX 124
City BROOHAVEN
State MS
ZIP 39602
Accounting period End 12
Primary contact name STACY LEGGETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK LEBLANC
TREASURER
107 BRADY DRIVE
BROOKHAVEN MS 39601

Officer/Director/Trustee Two

CLINT ROUNSAVILLE
SECRETARY
132 ARGYLE TRAIL SE
BOGUE CHITTO MS 39629

Officer/Director/Trustee Three

DUSTIN BAIRFIELD
PRESIDENT
1628 MAURA LANE
BROOKHAVEN MS 39601

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/19
Organization Incorporation State MS
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: Yes
Religious: No
Educational: No
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 Yes
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 MARK LEBLANC
Signature Title TREASURER
Signature Date 11/11/19

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