FORM 1023-EZ for VISUALLY IMPAIRED BLIND ATHLETES OFNORTHERN ARIZONA INC

Field Data
EIN 83-2758915
Case Number EO-2019084-000358
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VISUALLY IMPAIRED BLIND ATHLETES OFNORTHERN ARIZONA INC
Organization’s Mailing Address 3651 W RICHMOND VISTA DR
City MARANA
State AZ
ZIP 85658
Accounting period End 12
Primary contact name VICKI L NUMKENA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VICKI NUMKENA
PRESIDENT, CHAIR
PO BOX 145
DOLORES CO 81323

Officer/Director/Trustee Two

DORINDA RIFE
TREASURER
487 E HISTORIC ST
TUCSON AZ 85701

Officer/Director/Trustee Three

DIANE SHIFFLETT
SECRETARY
4521 W CAMINO DE CIELO
TUCSON AZ 85745

Officer/Director/Trustee Four

KEN BALL
BOARD MEMBER
650 N PENROD PMB 136
SHOW LOW AZ 85901

Officer/Director/Trustee Five

CHRISTINE MORENO
BOARD MEMBER
3538 E ELIDA ST
TUCSON AZ 85716-3209

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/29/18
Organization Incorporation State AZ
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: No
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 Yes
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 VICKI NUMKENA
Signature Title PRESIDENT, CHAIR
Signature Date 3/21/19

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