FORM 1023-EZ for MARK D SAMPLE FOOTBALL SCHOLARSHIPFUND

Field Data
EIN 83-3265753
Case Number EO-2019091-000516
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MARK D SAMPLE FOOTBALL SCHOLARSHIPFUND
Organization’s Mailing Address PO BOX 750584
City LAS VEGAS
State NV
ZIP 89136-584
Accounting period End 12
Primary contact name LUCIE SAMPLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LUCIE SAMPLE
PRESIDENT
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Two

JULIETA GONZALES
TREASURER
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Three

JORDAN HOFFMAN
VICE-PRESIDENT
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Four

OLIVIA GILLAM
SECRETARY
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Five

GUILLERMINA GONZALES
HISTORIAN
PO BOX 750584
LAS VEGAS NV 89136-584

Organization’s website
Organization’s email LUSAMPLE@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/19
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 LUCIE SAMPLE
Signature Title PRESIDENT
Signature Date 3/28/19
EIN 83-3265753
Case Number EO-2019091-000516
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MARK D SAMPLE FOOTBALL SCHOLARSHIP FUND
Organization’s Mailing Address PO BOX 750584
City LAS VEGAS
State NV
ZIP 89136-584
Accounting period End 12
Primary contact name LUCIE SAMPLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LUCIE SAMPLE
PRESIDENT
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Two

JULIETA GONZALES
TREASURER
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Three

JORDAN HOFFMAN
VICE-PRESIDENT
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Four

OLIVIA GILLAM
SECRETARY
PO BOX 750584
LAS VEGAS NV 89136-584

Officer/Director/Trustee Five

GUILLERMINA GONZALES
HISTORIAN
PO BOX 750584
LAS VEGAS NV 89136-584

Organization’s website
Organization’s email LUSAMPLE@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/23/19
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 LUCIE SAMPLE
Signature Title PRESIDENT
Signature Date 3/28/19

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