FORM 1023-EZ for BLACK LAB LACROSSE INC
| Field | Data |
|---|---|
| EIN | 82-4459626 |
| Case Number | EO-2018053-000198 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BLACK LAB LACROSSE INC |
| Organization’s Mailing Address | 9393 DAISY AVENUE |
| City | PALM BEACH GARDENS |
| State | FL |
| ZIP | 33410 |
| Accounting period End | 12 |
| Primary contact name | JUSTIN MOE |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
JUSTIN MOE
DIRECTOR
9393 DIASY AVENUE
PALM BEACH GARDENS FL 33410
Officer/Director/Trustee Two
ROBERT MAY
DIRECTOR
835 GREENBRIAR DRIVE
LAKE PARK FL 33403
Officer/Director/Trustee Three
TIFFANY MOE
DIRECTOR
9393 DAISY AVENUE
PALM BEACH GARDENS FL 33410
Officer/Director/Trustee Four
AFTON MAY
DIRECTOR
835 GREENBRIAR DRIVE
LAKE PARK FL 33403
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 1/16/18 |
| Organization Incorporation State | FL |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | N70 - Amateur Sports Competitions |
| 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 | Yes |
| Donation of funds | No |
| Conducting Activities Outside of United States | No |
| Financial transactions with officers | Yes |
| 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 | JUSTIN MOE |
| Signature Title | DIRECTOR |
| Signature Date | 2/20/18 |
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