FORM 1023-EZ for URBAN GOLF ACADEMY INC

Field Data
EIN 81-1480939
Case Number EO-2016109-000061
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name URBAN GOLF ACADEMY INC
Organization’s Mailing Address 34 BOW ST
City MILLIS
State MA
ZIP 02054
Accounting period End 12
Primary contact name ANDREW MIRKEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANDREW MIRKEN
MEMBER
34 BOW ST
MILLIS MA 02054

Officer/Director/Trustee Two

HARRY ROSE
MEMBER
288 FOREST GROVE AVE
WRENTHAM MA 02093

Officer/Director/Trustee Three

DARNELL WILLIAMS
MEMBER
31 HAWTHORNE ST
ROXBURY MA 02119

Officer/Director/Trustee Four

JEFF PILTCH
MEMBER
743 E 4TH ST UNIT 103
BOSTON MA 02127

Organization’s website WWW.URBANGOLFACADEMY.ORG
Organization’s email COACHMIRKEN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2016
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N6A - Golf
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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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