FORM 1023-EZ for NORTH METRO BLAZERS

Field Data
EIN 81-3732979
Case Number EO-2016250-000184
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTH METRO BLAZERS
Organization’s Mailing Address 6833 CATTAIL CT S
City COTTAGE GROVE
State MN
ZIP 55016
Accounting period End 6
Primary contact name SCOTT GERVAIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT GERVAIS
PRESIDENT
6833 CATTAIL CT S
COTTAGE GROVE MN 55016

Officer/Director/Trustee Two

TERRY ANDERSON
TREASURER
8922 VINEWOOD LN
MAPLE GROVE MN 55369

Officer/Director/Trustee Three

ROB OLSON
BOARD MEMBER
11550 39TH AVE N
PLYMOUTH MN 55441

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/25/2010
Organization Incorporation State MN
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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