FORM 1023-EZ for NYACK YOUTH LACROSSE INC

Field Data
EIN 47-1181989
Case Number EO-2015008-000154
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NYACK YOUTH LACROSSE INC
Organization’s Mailing Address 184 COUNTRY CLUB LANE
City POMONA
State NY
ZIP 10970
Accounting period End 12
Primary contact name DAVID GOLDSTEIN ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JUSTIN HENRY
PRESIDENT, DIRECTOR
184 COUNTRY CLUB LANE
POMONA NY 10970

Officer/Director/Trustee Two

KATHRYN PERRELLA
VICE PRESIDENT, SECRETARY, DIRECTOR
184 COUNTRY CLUB LANE
POMONA NY 10970

Officer/Director/Trustee Three

JULIAN GOULD
TREASURER, DIRECTOR
184 COUNTRY CLUB LANE
POMONA NY 10970

Officer/Director/Trustee Four

ROBERT LEWIS
DIRECTOR
184 COUNTRY CLUB LANE
POMONA NY 10970

Officer/Director/Trustee Five

JEFF RAMOS
DIRECTOR
184 COUNTRY CLUB LANE
POMONA NY 10970

Organization’s website WWW.NYACKYOUTHLACROSSE.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/9/2014
Organization Incorporation State NY
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: 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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