FORM 1023-EZ for DLB GOALIE ACADEMY INC

Field Data
EIN 81-1047817
Case Number EO-2016040-000115
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DLB GOALIE ACADEMY INC
Organization’s Mailing Address 469 CENTERVILLE RD SUITE 206
City WARWICK
State RI
ZIP 02886
Accounting period End 12
Primary contact name JOSEPH P ACCETTURO ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KATERINA LEFORT
DIRECTOR
29 BRIAR DR
MILFORD MA 01757

Officer/Director/Trustee Two

GILBERT LEFORT
DIRECTOR
725 MOWRY ST
HARRISVILLE RI 02830

Officer/Director/Trustee Three

DEBORAH LEFORT
DIRECTOR
5955 SW 58TH PLACE
OCALA FL 34474

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2016
Organization Incorporation State RI
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: Yes
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
Signature Title
Signature Date

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