FORM 1023-EZ for PK4L BOOSTER CLUB

Field Data
EIN 82-2175042
Case Number EO-2017219-000184
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PK4L BOOSTER CLUB
Organization’s Mailing Address 441 N RENSSELAER
City GRIFFITH
State IN
ZIP 46319
Accounting period End 6
Primary contact name JAMES D LONG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES LONG
PRESIDENT
441 N RENSSELAER
GRIFFITH IN 46319

Officer/Director/Trustee Two

RUDY CIMA DE VILLA
VICE PRESIDENT
515 S LAFAYETTE
GRIFFITH IN 46319

Officer/Director/Trustee Three

STEPH REX
VICE PRESIDENT
423 N LILLIAN
GRIFFITH IN 46319

Officer/Director/Trustee Four

DEANNA SHAPIRO
TREASURER
505 OXFORD CIRCLE
GRIFFITH IN 46319

Officer/Director/Trustee Five

ROBERT BUBALA
SECRETARY
1103 E MILLER
GRIFFITH IN 46319

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/2017
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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