FORM 1023-EZ for PLEASANT VALLEY WRESTLING CLUB

Field Data
EIN 61-1772657
Case Number EO-2015301-000299
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PLEASANT VALLEY WRESTLING CLUB
Organization’s Mailing Address 13 RAINBOW DRIVE
City BETTENDORF
State IA
ZIP 52722
Accounting period End 12
Primary contact name JACOB LARSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JACOB LARSEN
BOARD MEMBER
13 RAINBOW DRIVE
BETTENDORF IA 52722

Officer/Director/Trustee Two

ILANA BOHREN
BOHREN
27572 FREDRICK DRIVE
LECLAIRE IA 52753

Officer/Director/Trustee Three

BOB BOYER
BOARD MEMBER
25820 VALLEY DRIVE
BETTENDORF IA 52722

Officer/Director/Trustee Four

STACEY CLARK
BOARD MEMBER
200 PARK AVENUE
BETTENDORF IA 52722

Officer/Director/Trustee Five

MATT SCHMIDT
BOARD MEMBER
27998 229TH STREET
LECLAIRE IA 52753

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/28/2015
Organization Incorporation State IA
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: Yes
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 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
Signature Title
Signature Date

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