FORM 1023-EZ for NEW JERSEY ROLLER DERBY

Field Data
EIN 83-2452773
Case Number EO-2019081-000453
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NEW JERSEY ROLLER DERBY
Organization’s Mailing Address 27 LEARY AVE
City BLOOMINGDALE
State NJ
ZIP 7403
Accounting period End 12
Primary contact name REBECCA KARGER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BARBI GNECCO
PRESIDENT
27 LEARY AVE
BLOOMINGDALE NJ 7403

Officer/Director/Trustee Two

REBECCA KARGER
VICE PRESIDENT
54 BUDD STREET
MORRISTOWN NJ 7960

Officer/Director/Trustee Three

JAMIE KYNN
SECRETARY
42 NEW YORK AVE
NEWARK NJ 7105

Officer/Director/Trustee Four

KRISTINA DELORENZO GARZIO
TREASURER
126 GEORGANNA DRIVE
EAST STROUDSBURG PA 18302

Officer/Director/Trustee Five

SHAWNEE BOURENKO
WFTDA REPRESENTATIVE
23 KITCHEN ROAD
ASBURY NJ 8802

Organization’s website NJDERBY.COM
Organization’s email NEWJERSEYROLLERDERBY@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/12/11
Organization Incorporation State NJ
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 REBECCA KARGER
Signature Title VICE PRESIDENT
Signature Date 3/20/19

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