FORM 1023-EZ for PA AFTERSHOCK 00

Field Data
EIN 47-3120830
Case Number EO-2015049-000246
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PA AFTERSHOCK 00
Organization’s Mailing Address 526 PINE CREEK AVENUE
City JERSEY SHORE
State PA
ZIP 17740
Accounting period End 12
Primary contact name ERIC DERSHEM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DUSTIN STRAUB
MANAGER
526 PINE CREEK AVENUE
JERSEY SHORE PA 17740

Officer/Director/Trustee Two

ERIC DERSHEM
COACH
200 EAST BALD EAGLE STREET APT 2
LOCK HAVEN PA 17745

Officer/Director/Trustee Three

DOUGLAS BRUSH
COACH
128 NOLL DRIVE
MILL HALL PA 17751

Officer/Director/Trustee Four

JAY MILLER
COACH
35 WALKER ROAD
LOCK HAVEN PA 17745

Officer/Director/Trustee Five

NICOLE MILLER
FACILITY COORDINATOR
35 WALKER ROAD
LOCK HAVEN PA 17745

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2011
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N63 - Baseball, Softball
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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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