FORM 1023-EZ for LOCKEFORD LIBERATORS ROLLER DERBY

Field Data
EIN 81-4208228
Case Number EO-2018135-000275
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LOCKEFORD LIBERATORS ROLLER DERBY
Organization’s Mailing Address 13264 E HWY 88
City LOCKEFORD
State CA
ZIP 95237
Accounting period End 5
Primary contact name CASEY LARA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CASEY LARA
PRESIDENT
13264 E HWY 88
LOCKEFORD CA 95237

Officer/Director/Trustee Two

MICHELLE CIOLI
VICE PRESIDENT
PO BOX 1201
LOCKEFORD CA 95237

Officer/Director/Trustee Three

KATHRYN CAPPS
SECRETARY
14481 COQUILLE CT
LOCKEFORD CA 95237

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/24/16
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CASEY LARA
Signature Title PRESIDENT
Signature Date 5/9/18

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