FORM 1023-EZ for COMMUNITY ROLLER SPORTS ACADEMY

Field Data
EIN 82-4428779
Case Number EO-2018108-000216
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY ROLLER SPORTS ACADEMY
Organization’s Mailing Address 2965 ALMOND STREET
City DOS PALOS
State CA
ZIP 93620
Accounting period End 12
Primary contact name VERONICA MENDOZA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID ALLEN
PRESIDENT/DIRECTOR
221 BRAVADA CIRCLE
HOLLISTER CA 95023

Officer/Director/Trustee Two

CHRISTINA WHITCOMB
VICE PRESIDENT
1830 CHEYENNE DRIVE
MERCED CA 95348

Officer/Director/Trustee Three

DIANA LUTZ
SECRETARY/DIRECTOR
731 WILKINSON COURT
DOS PALOS CA 93620

Officer/Director/Trustee Four

GABRIELA SOTO
TREASURER
3211 TOGNINALI LANE
STOCKTON CA 95206

Officer/Director/Trustee Five

VERONICA MENDOZA
DIRECTOR
103 JENSEN ROAD
GUSTINE CA 95322

Organization’s website
Organization’s email COMMUNITYROLLERSPORTSACADEMY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/14/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
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 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 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 VERONICA MENDOZA
Signature Title DIRECTOR
Signature Date 3/20/18

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