FORM 1023-EZ for NEWBERG MAT CLUB INC

Field Data
EIN 38-4027135
Case Number EO-2017248-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NEWBERG MAT CLUB INC
Organization’s Mailing Address 21585 NE HIDDEN SPRINGS RD
City DUNDEE
State OR
ZIP 97115
Accounting period End 12
Primary contact name KATIE IRELAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TOM SMITH
PRESIDENT
21585 NE HIDDEN SPRINGS RD
DUNDEE OR 97115

Officer/Director/Trustee Two

JUSTIN HAMPTON
V. PRESIDENT
18780 NE CHEHALEM DR
NEWBERG OR 97132

Officer/Director/Trustee Three

CASSIE GARVER
SECRETARY
5218 WEDGEWOOD LP
NEWBERG OR 97132

Officer/Director/Trustee Four

AMANDA BOWLBY
TRESURER
3633 BUR OAK CT
NEWBERG OR 97132

Officer/Director/Trustee Five

ANIELLO RUSSO
DIRECTOR
27535 SW 207TH AVE
SHERWOOD OR 97140

Organization’s website WWW.NEWBERGMATCLUB.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2017
Organization Incorporation State OR
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: Yes
Religious: No
Educational: Yes
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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