FORM 1023-EZ for INDIANA BREAKERS ORGANZATION

Field Data
EIN 45-2117081
Case Number EO-2016243-000020
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INDIANA BREAKERS ORGANZATION
Organization’s Mailing Address 2553 NAPLES DRIVE
City VALPARAISO
State IN
ZIP 46385
Accounting period End 4
Primary contact name SCOTT ELLRICH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT ELLRICH
PRESIDENT
2553 NAPLES DRIVE
VALPARAISO IN 46385

Officer/Director/Trustee Two

RALPH BUFANO
CONTROLLER
1816 MAIN STREET
VALPRAISO IN 46385

Officer/Director/Trustee Three

CHRIS SMITH
VICE PRESIDENT
2251 BEUATY CREEK DRIVE
VALPRAISO IN 46383

Officer/Director/Trustee Four

SCOTT ELLRICH
PRESIDENT
2553 NAPLES DRIVE
VALPARAISO IN 46385

Officer/Director/Trustee Five

SCOTT ELLRICH
PRESIDENT
2553 NAPLES DRIVE
VALPARAISO IN 46385

Organization’s website
Organization’s email ISUAL@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/11/2011
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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