FORM 1023-EZ for CLAY BREAKERS CLUB INC

Field Data
EIN 47-5152024
Case Number EO-2017271-000191
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLAY BREAKERS CLUB INC
Organization’s Mailing Address 56428 160TH STREET
City AUSTIN
State MN
ZIP 55912
Accounting period End 6
Primary contact name RONALD MEYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFREY RETTERATH
PRESIDENT
56428 160TH STREET
AUSTIN MN 55912

Officer/Director/Trustee Two

TRICIA OLINGER
TREASURER
605 19TH STREET NW
AUSTIN MN 55912

Officer/Director/Trustee Three

STEPHANIE RETTERATH
SECRETARY
56428 160TH STREET
AUSTIN MN 55912

Officer/Director/Trustee Four

RONALD MEYER
VICE PRESIDENT
911 4TH AVENUE NW
AUSTIN MN 55912

Officer/Director/Trustee Five

LAURA GRUNEWALD
ASSISTANT VICE PRESIDENT
702 10TH STREET NW
AUSTIN MN 55912

Organization’s website
Organization’s email RETTERATH.21@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/19/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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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