FORM 1023-EZ for KAYSVILLE ROBOTICS ASSOCIATION

Field Data
EIN 83-1936159
Case Number EO-2018263-000460
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KAYSVILLE ROBOTICS ASSOCIATION
Organization’s Mailing Address 676 N 300 E
City KAYSVILLE
State UT
ZIP 84037
Accounting period End 12
Primary contact name DANE LEIFSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANE LEIFSON
DIRECTOR
4444 S 1025 W
RIVERDALE UT 84405

Officer/Director/Trustee Two

BRAD HEATON
DIRECTOR
2057 S 400 E
KAYSVILLE UT 84037

Officer/Director/Trustee Three

EMILY SHUNN
DIRECTOR
676 N 300 E
KAYSVILLE UT 84037

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/18
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 DANE LEIFSON
Signature Title DIRECTOR
Signature Date 9/18/18

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