FORM 1023-EZ for SALT LAKE ROLLER DERBY

Field Data
EIN 84-4925181
Case Number EO-2020125-000406
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SALT LAKE ROLLER DERBY
Organization’s Mailing Address 94 CARLSON AVE
City MIDVALE
State UT
ZIP 84047-1524
Accounting period End 12
Primary contact name SUSAN JOHNSTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN JOHNSTON
DIRECTOR
94 CARLSON AVE
MIDVALE UT 84047-1524

Officer/Director/Trustee Two

BLAKE BISHOP
DIRECTOR
3381 REXFORD PLACE
COTTONWOOD HEIGHTS UT 84121-5826

Officer/Director/Trustee Three

HOLLY BISHOP
DIRECTOR
3381 REXFORD PLACE
COTTONWOOD HEIGHTS UT 84121-5826

Officer/Director/Trustee Four

JENNIFER PARSONS
DIRECTOR
1150 EAST 100 SOUTH
SALT LAKE CITY UT 84102-1640

Organization’s website
Organization’s email SALTLAKEROLLERDERBY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/11/2020
Organization Incorporation State UT
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 SUSAN JOHNSTON
Signature Title DIRECTOR
Signature Date 5/1/2020

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