FORM 1023-EZ for DERBY CITY ROLLER GIRLS

Field Data
EIN 47-2762148
Case Number EO-2015128-000511
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DERBY CITY ROLLER GIRLS
Organization’s Mailing Address 216 IVY POINTE DRIVE
City ELIZABETHTOWN
State KY
ZIP 42701
Accounting period End 12
Primary contact name AMY CATT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AMY CATT
PRESIDENT
2810 BLACKISTONMILL ROAD
CLARKSVILLE IN 47129

Officer/Director/Trustee Two

JESSICA DUBAY
TREASURER
635 LOUIS COLEMAN JR DRIVE
LOUISVILLE KY 40211

Officer/Director/Trustee Three

JENNIFER HARLAN
VICE PRESIDENT
1702 MARLOWE DRIVE
CLARKSVILLE IN 47129

Officer/Director/Trustee Four

ELAINE NICHOLAS
SECRETARY
216 IVY POINTE DRIVE
ELIZABETHTOWN KY 42701

Officer/Director/Trustee Five

GINA MOSES
DIRECTOR
3505 NANZ AVENUE
LOUISVILLE KY 40207

Organization’s website WWW.DERBYCITYROLLERGIRLS.COM
Organization’s email INFO@DERBYCITYROLLERGIRLS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/20/2015
Organization Incorporation State KY
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 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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