FORM 1023-EZ for MIDWESTERN BLAZING SADDLES

Field Data
EIN 47-4535481
Case Number EO-2016190-000146
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MIDWESTERN BLAZING SADDLES
Organization’s Mailing Address 7419 HELMSLEY GREEN
City NEW ALBANY
State OH
ZIP 43054-8153
Accounting period End 12
Primary contact name TIMOTHY L SMITH CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH BEREND
DIRECTOR, PRESIDENT
7419 HELMSLEY GREEN
NEW ALBANY OH 43054-8153

Officer/Director/Trustee Two

CINDY BEREND
DIRECTOR
7419 HELMSLEY GREEN
NEW ALBANY OH 43054-8153

Officer/Director/Trustee Three

MICHAEL BEREND
DIRECTOR, TREASURER
1335 NORTH PARK AVENUE
INDIANAPOLIS IN 46202-2640

Officer/Director/Trustee Four

ROCCO MAIOLO
DIRECTOR, VICE PRESIDENT
1594 GRAYLING COURT
COLUMBUS OH 43235-5950

Officer/Director/Trustee Five

RICK MILLER
DIRECTOR, SECRETARY
18735 UTICA ROAD
UTICA OH 43080-9481

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/23/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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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