FORM 1023-EZ for BREAK MY GAME INC

Field Data
EIN 85-1664251
Case Number EO-2021063-000308
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BREAK MY GAME INC
Organization’s Mailing Address 418 CROSS CREEK CT
City CHESTER
State MD
ZIP 21619
Accounting period End 6
Primary contact name DANIEL PALMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL PALMER
PRESIDENT
418 CROSS CREEK CT
CHESTER MD 21619

Officer/Director/Trustee Two

MATTHEW HOCKER
CHAIRMAN
5239 DUNSTABLE LN
ALEXANDRIA VA 22315

Officer/Director/Trustee Three

DAVID PALMER
VICE-CHAIR
2275 S 200 E APT 2
SALT LAKE CITY UT 84115

Officer/Director/Trustee Four

VERONICA DIAZ
SECRETARY
403 STOCKTON ST APT 4357
RICHMAND VA 23224

Officer/Director/Trustee Five

JOSEPH FREDRICK
DIRECTOR
8611 LAGRANGE ST
LORTON VA 22079

Organization’s website WWW.BREAKMYGAME.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/2020
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N03 - Professional Societies, Associations
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DANIEL PALMER
Signature Title PRESIDENT
Signature Date 12/28/2020

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