FORM 1023-EZ for MOUNT CLEMENS HOCKEY CLUB

Field Data
EIN 47-5126311
Case Number EO-2015268-000252
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOUNT CLEMENS HOCKEY CLUB
Organization’s Mailing Address 200 N GROESBECK
City MOUNT CLEMENS
State MI
ZIP 48043
Accounting period End 6
Primary contact name NICK POLISKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NICK POLISKI
MANAGING DIRECTOR
19955 CHESTERBROOK
MACOMB MI 48044

Officer/Director/Trustee Two

JEFF BLUM
DIRECTOR OF OPERATIONS
4087 ELAINE
PORT HURON MI 48060

Officer/Director/Trustee Three

ANDY WADE
ASST. DIRECTOR OF OPERATIONS
45807 WAKEFILED
SHELBY TOWNSHIP MI 48317

Organization’s website WWW.MOUNTCLEMENSHOCKEY.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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
Signature Title
Signature Date

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