FORM 1023-EZ for BLACK BOX YOUTH PLAYHOUSE

Field Data
EIN 84-4213512
Case Number EO-2020010-000482
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK BOX YOUTH PLAYHOUSE
Organization’s Mailing Address POST OFFICE BOX 1646
City SHEPHERDSTOWN
State WV
ZIP 25443
Accounting period End 12
Primary contact name LAURA RICHARDS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAURA RICHARDS BAKIN
OFFICER
POST OFFICE BOX 1646
SHEPHERDSTOWN WV 25443

Officer/Director/Trustee Two

PATRICIA RUCKER
DIRECTOR
2432 CHESTNUT HILL ROAD
HARPERS FERRY WV 25425

Officer/Director/Trustee Three

ED LUTZ
DIRECTOR
2484 SWAN POND ROAD
MARTINSBURG WV 25404

Organization’s website BLACKBOXYOUTH.ORG
Organization’s email BLACKBOXYOUTHPLAYHOUSE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/8/2020
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
Organization’s purpose Charitable: Yes
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 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 LAURA RICHARDS BAKIN
Signature Title OFFICER
Signature Date 1/8/2020

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