FORM 1023-EZ for XTREME SPORTS & FITNESS

Field Data
EIN 83-3045372
Case Number EO-2019042-000345
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name XTREME SPORTS & FITNESS
Organization’s Mailing Address 403 WINDING HILLS DR
City CLINTON
State MS
ZIP 39056
Accounting period End 12
Primary contact name LAVELL WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAVELL WILLIAMS
PRESIDENT, DIRECTOR
403 WINDING HILLS DR
CLINTON MS 39056

Officer/Director/Trustee Two

GREGORY WASHINGTON
SECRETARY, DIRECTOR
14C LANDRUM DR
DURANT MS 39063

Officer/Director/Trustee Three

REBEKAH TUCKER
TREASURER, DIRECTOR
5155 KEELE ST APT 9D
JACKSON MS 39206

Officer/Director/Trustee Four

TERRANCE ROBINSON
DIRECTOR
334 GREENGATE CIR
BRANDON MS 39042

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/4/19
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name LAVELL WILLIAMS
Signature Title PRESIDENT, DIRECTOR
Signature Date 2/8/19

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