FORM 1023-EZ for DERBY DEVILS INC

Field Data
EIN 82-2528267
Case Number EO-2017248-000326
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DERBY DEVILS INC
Organization’s Mailing Address C/O 205 S RANDOLPH STREET
City STACYVILLE
State IA
ZIP 50476
Accounting period End 12
Primary contact name TODD R BUCHANAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAWN KREBSBACH
PRESIDENT AND DIRECTOR
205 S RANDOLPH STREET
STACYVILLE IA 50476

Officer/Director/Trustee Two

SHARI TEGTMEIER-SMITH
DIRECTOR
104 S MAIN
ST ANSGAR IA 50472

Officer/Director/Trustee Three

ERIN LINES-MYERS
VICE PRESIDENT AND DIRECTOR
3481 LANCER AVENUE
OSAGE IA 50461

Officer/Director/Trustee Four

JESSICA BLEEKER-CLAYTON
SECRETARY/TREASURER/DIRECTOR
190 N RANDOLPH STREET
MITCHELL IA 50461

Officer/Director/Trustee Five

WAYNE HOUSEHOLDER
DIRECTOR
3504 - 30TH AVENUE
FENTON IA 50539

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/31/2017
Organization Incorporation State IA
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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