FORM 1023-EZ for KTA TAE KWON DO BOOSTER CLUB

Field Data
EIN 47-3915231
Case Number EO-2015163-000457
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KTA TAE KWON DO BOOSTER CLUB
Organization’s Mailing Address 6904 MATTHEWS MINT HILL ROAD
City MINT HILL
State NC
ZIP 28227
Accounting period End 12
Primary contact name JOHN BURKART
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOHN BURKART
CHAIRMAN
1501 SHANELLE LANE
MATTHEWS NC 28104

Officer/Director/Trustee Two

SUZANNE PUGH
TREASURER
8230 WHITE ASH CT
MINT HILL NC 28227

Officer/Director/Trustee Three

TODD WILSON
SECRETARY
111 ANTIOCH PLANTATION ROAD
MATTHEWS NC 28104

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/30/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
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 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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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