FORM 1023-EZ for WESTERN PA TEAM BASS SERIES

Field Data
EIN 81-4960958
Case Number EO-2017017-000446
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WESTERN PA TEAM BASS SERIES
Organization’s Mailing Address 138 PINE ST
City ALLPORT
State PA
ZIP 16821
Accounting period End 12
Primary contact name GEORGE S HOLENCIK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID KINDLEBERGER
PRESIDENT
PO BOX 5
LANSE PA 16849

Officer/Director/Trustee Two

JAMES HOLENCIK
VICE PRESIDENT
232 OAK GROVE LANE
BROOKVILLE PA 15825

Officer/Director/Trustee Three

DREW DAVIS
SECRETARY
1220 GRANT ST EXTENSION
REYNOLDSVILLE PA 15851

Officer/Director/Trustee Four

MICHAEL ELDRIDGE
TREASURER
PO BOX 309
BLACKLICK PA 15716

Officer/Director/Trustee Five

GEORGE HOLENCIK
VICE PRESIDENT
138 PINE STREET
ALLPORT PA 16821

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/7/2017
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N61 - Fishing, Hunting Clubs
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 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
Signature Title
Signature Date

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