FORM 1023-EZ for SALT CITY ROCK BLUES INC

Field Data
EIN 82-1232755
Case Number EO-2017139-000264
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SALT CITY ROCK BLUES INC
Organization’s Mailing Address 102 LIGHTHOUSE WAY N
City MANISTEE
State MI
ZIP 49660
Accounting period End 12
Primary contact name PAUL ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAUL ANDERSON
PRESIDENT
9057 JOHNSON RD
KALEVA MI 49645

Officer/Director/Trustee Two

ROBERT OGILVIE
VICE PRESIDENT
6041 N REEK RD
FOUNTAIN MI 49410

Officer/Director/Trustee Three

SUSAN FLARITY
TREASURER
102 LIGHTHOUSE WAY N
MANISTEE MI 49660

Officer/Director/Trustee Four

TOM VOLKEMA
SECRETARY
5927 BRANDT RD
BEAR LAKE MI 49614

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2017
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A68 - Music
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 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
Signature Title
Signature Date

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