FORM 1023-EZ for CROSS CREEK CYCLING CLUB

Field Data
EIN 37-1477138
Case Number EO-2016314-000352
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CROSS CREEK CYCLING CLUB
Organization’s Mailing Address PO BOX 53039
City FAYETTEVILLE
State NC
ZIP 28305-3039
Accounting period End 12
Primary contact name BOB MIARER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT HAVENS
PRESIDENT
1005 BUFFALO LAKE ROAD
SANFORD NC 27332

Officer/Director/Trustee Two

BOB MIARER
TREASURER
3301 SEVEN MOUNTAIN DRIVE
FAYETTEVILLE NC 28306

Officer/Director/Trustee Three

TERRY SLACK
SECRETARY
5135 GOSHAWK DR
HOPE MILLS NC 28348

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/22/2003
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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