FORM 1023-EZ for MISSISSIPPI DELTA BLUES CAMP

Field Data
EIN 84-2764110
Case Number EO-2019322-000194
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MISSISSIPPI DELTA BLUES CAMP
Organization’s Mailing Address 11203 HIGHWAY 322 BELLVIEW RD
City CLARKSDALE
State MS
ZIP 38614
Accounting period End 12
Primary contact name KATRINA NEAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATRINA NEAL
PRESIDENT/CHAIR
11203 HIGHWAY 322 BELLVIEW RD
CLARKSDALE MS 38614

Officer/Director/Trustee Two

NIKKI HALL
TREASURER
11203 HIGHWAY 322 BELLVIEW RD
CLARKSDALE MS 38614

Officer/Director/Trustee Three

STEPHANIE COLE
SECRETARY
11203 HIGHWAY 322 BELLVIEW RD
CLARKSDALE MS 38614

Officer/Director/Trustee Four

DARRYL YOUNG
DIRECTOR
11203 HIGHWAY 322 BELLVIEW RD
CLARKSDALE MS 38614

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/16/19
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N20 - Recreational and Sporting Camps
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 KATRINA NEAL
Signature Title PRESIDENT/CHAIR
Signature Date 11/14/19

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