FORM 1023-EZ for WESTERN BROWN YOUTH SOCCER ASSOCIATION

Field Data
EIN 84-3436454
Case Number EO-2019360-000163
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WESTERN BROWN YOUTH SOCCER ASSOCIATION
Organization’s Mailing Address P O BOX 61
City MT ORAB
State OH
ZIP 45154
Accounting period End 12
Primary contact name TOM KURSIM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TOM KURSIM
PRESIDENT
1990 PINE QUEST DR
WILLIAMSBURG OH 45176

Officer/Director/Trustee Two

TRINA JONES
VICE PRESIDENT
121 HERITAGE DR
MT ORAB OH 45154

Officer/Director/Trustee Three

AMANDA BREWER
SECRETARY
14098 HOLIDAY DR
MT ORAB OH 45154

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/17/2019
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: No
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TOM KURSIM
Signature Title PRESIDENT
Signature Date 12/20/2019

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