FORM 1023-EZ for BLACK-N-BLUEGRASS JUNIOR ROLLER DERBY

Field Data
EIN 46-5112869
Case Number EO-2018140-000186
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK-N-BLUEGRASS JUNIOR ROLLER DERBY
Organization’s Mailing Address 7606 CLOUDSTONE DR
City FLORENCE
State KY
ZIP 41042
Accounting period End 12
Primary contact name LEEANNA BARNES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICTORIA SAPP
PRESIDENT
202 ELECTRIC AVE
SOUTHGATE KY 41071

Officer/Director/Trustee Two

LEANN SANDERS
VICE PRESIDENT
3371 ALEXIS RD
CINCINNATI OH 45239

Officer/Director/Trustee Three

ANNETTE GROOMS
SECRETARY
2727 IOWA AVE
COVINGTON KY 41015

Officer/Director/Trustee Four

LEEANNA BARNES
TREASURER
7606 CLOUDSTONE DR
FLORENCE KY 41042

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/14/14
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: 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 LEEANNA BARNES
Signature Title TREASURER
Signature Date 5/15/18

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