FORM 1023-EZ for GRASS LAKE YOUTH WRESTLING CLUB

Field Data
EIN 47-1483421
Case Number EO-2015033-000406
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GRASS LAKE YOUTH WRESTLING CLUB
Organization’s Mailing Address PO BOX 176
City GRASS LAKE
State MI
ZIP 49240-0176
Accounting period End 12
Primary contact name JESSE PAYNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAVID ALLEN
FOUNDER/COACH
10079 PORTAGE LAKE RD
MUNITH MI 49259-9602

Officer/Director/Trustee Two

JESSE PAYNE
CLUB PRESIDENT
4796 TRUMBLE RD
JACKSON MI 49201-7650

Organization’s website
Organization’s email GLYOUTHWRESTLING@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/1/2014
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 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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