FORM 1023-EZ for COACH SAM BURLEY FOUNDATION INC

Field Data
EIN 26-4065252
Case Number EO-2014332-000140
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COACH SAM BURLEY FOUNDATION INC
Organization’s Mailing Address 16910 SW 107TH CT
City MIAMI
State FL
ZIP 33157
Accounting period End 12
Primary contact name SAM BURLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SAM BURLEY
PRESIDENT, DIRECTOR
16910 SW 107TH CT
MIAMI FL 33157

Officer/Director/Trustee Two

JAMES WHITE
SECRETARY, DIRECTOR
2695 COUNTY ROAD 783
ALVIN TX 77511

Officer/Director/Trustee Three

LAWRENCE KENNEDY
TREASURER, DIRECTOR
1400 NW 53RD ST
MIAMI FL 33142

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/12/2009
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 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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