FORM 1023-EZ for RIVER CITY JUNIOR ROLLER DERBY

Field Data
EIN 47-2304878
Case Number EO-2015119-000282
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RIVER CITY JUNIOR ROLLER DERBY
Organization’s Mailing Address 635 LOUIS COLEMAN JR DR
City LOUISVILLE
State KY
ZIP 40211
Accounting period End 12
Primary contact name JESSICA DUBAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AMY CATT
PRESIDENT
2810 BLACKISTON MILL RD
CLARKSVILLE IN 47129-9021

Officer/Director/Trustee Two

JESSICA DUBAY
TREASUERER
635 LOUIS COLEMAN JR DRIVE
LOUISVILLE KY 40211-2801

Officer/Director/Trustee Three

DEIDRE FUELLING
DIRECTOR
9105 PINE SPRINGS DRIVE
LOUISVILLE KY 40291-4761

Officer/Director/Trustee Four

LEANNE DUEFFERT
DIRECTOR
2810 BLACKISTON MILL RD
CLARKSVILLE IN 47129-9021

Officer/Director/Trustee Five

SHELLEY PALMER
DIRECTOR
571 RIVER ROAD
LOUISVILLE KY 40059-9643

Organization’s website
Organization’s email INFO@RIVERCITYJUNIORDERBY.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/12/2014
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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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