FORM 1023-EZ for CONKLIN YOUTH BOOSTER CLUB

Field Data
EIN 47-4195200
Case Number EO-2018095-000604
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONKLIN YOUTH BOOSTER CLUB
Organization’s Mailing Address PO BOX 575
City CONKLIN
State NY
ZIP 13748-1408
Accounting period End 12
Primary contact name DAN MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN MILLER
PRESIDENT
123 WOODCREST WAY
CONKLIN NY 13748-1408

Officer/Director/Trustee Two

TOM BIEBER
VICEPRESIDENT
45 WOODCREST WAY
CONKLIN NY 13748-1408

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/1/15
Organization Incorporation State NY
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: Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAN MILLER
Signature Title PRESIDENT
Signature Date 3/22/18

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