FORM 1023-EZ for CLUB BLUE OF THE AUSTIN AREA

Field Data
EIN 81-3028991
Case Number EO-2016190-000618
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLUB BLUE OF THE AUSTIN AREA
Organization’s Mailing Address 7004 BEE CAVE ROAD BLG 3 STE 300
City AUSTIN
State TX
ZIP 78746
Accounting period End 12
Primary contact name KEVIN WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LARS ANDERSON
DIRECTOR
214 BARTON SPRINGS APT 713
AUSTIN TX 78704

Officer/Director/Trustee Two

JON BROSCIOUS
DIRECTOR
115 SANDRA MURAIDA WAY APT 334
AUSTIN TX 78703

Officer/Director/Trustee Three

ALANIA CATER
DIRECTOR
3001 DE CURTO ROAD UNIT 36
AUSTIN TX 78704

Officer/Director/Trustee Four

KEVIN WHITE
DIRECTOR
3309 GLENVIEW AVENUE
AUSTIN TN 78703

Officer/Director/Trustee Five

ALEX DURHAM
DIRECTOR
915 A BEAVER
AUSTIN TX 78746

Organization’s website HTTPS://WWW.FACEBOOK.COM/CLUBBLUEAUSTIN/?FREF=TS
Organization’s email CLUBBLUEOFTHEAUSTINAREA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/3/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
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 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
Signature Title
Signature Date

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