FORM 1023-EZ for PATRIOTUSA WRESTLING INC

Field Data
EIN 83-2091453
Case Number EO-2019156-000199
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PATRIOTUSA WRESTLING INC
Organization’s Mailing Address 20 LEFT GROVE AVENUE
City MINERAL WELLS
State WV
ZIP 26150
Accounting period End 5
Primary contact name DAVID JEFFREY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID JEFFREY
PRESIDENT
20 LEFT GROVE AVENUE
MINERAL WELLS WV 26150

Officer/Director/Trustee Two

TIMOTHY AMOS
SECRETARY
215 PLANTATION DRIVE
MINERAL WELLS WV 26150

Officer/Director/Trustee Three

BETSY QUIOCHO
TREASURER
6307 PIKE STREET
PARKERSBURG WV 26101

Organization’s website
Organization’s email PATRIOTUSA@EMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/19/18
Organization Incorporation State WV
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAVID JEFFREY
Signature Title PRESIDENT
Signature Date 6/3/19

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