FORM 1023-EZ for CASA GRANDE ROLLER DERBY

Field Data
EIN 82-5041255
Case Number EO-2018106-000902
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CASA GRANDE ROLLER DERBY
Organization’s Mailing Address 2077 N DISCOVERY LN
City CASA GRANDE
State AZ
ZIP 85122-6113
Accounting period End 12
Primary contact name KELLI BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLI BROWN
PRESIDENT/ INCORPORATOR
2077 N DISCOVERY LN
CASA GRANDE AZ 85122-6113

Officer/Director/Trustee Two

HARPER COWLEY
SECRETARY/ BUSINESS MANAGER
700 E RODEO RD APT 323
CASA GRANDE AZ 85122

Officer/Director/Trustee Three

ANGIE MCKINLAY
TREASURER
17085 W HOPI DR
CASA GRANDE AZ 85122

Officer/Director/Trustee Four

SHELLY GILBERT
OFFICER
226 W BARRUS PL
CASA GRANDE AZ 85122

Officer/Director/Trustee Five

JESSICA LEARY
OFFICER
296 S SAN LUIS REY TRL
CASA GRANDE AZ 85194

Organization’s website
Organization’s email CASAGRANDEROLLERDERBY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/5/17
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KELLI BROWN
Signature Title PRESIDENT/ INCORPORATOR
Signature Date 4/3/18

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