FORM 1023-EZ for NEW BERLIN WEST YOUTH FOOTBALL CLUBINC

Field Data
EIN 39-1996821
Case Number EO-2016070-000378
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NEW BERLIN WEST YOUTH FOOTBALL CLUBINC
Organization’s Mailing Address 3530 S WOODLAND COURT
City NEW BERLIN
State WI
ZIP 53146
Accounting period End 12
Primary contact name RHIANNON BLAWAT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JASON BLAWAT
PRESIDENT
3530 S WOODLAND CT
NEW BERLIN WI 53146

Officer/Director/Trustee Two

RHIANNON BLAWAT
TREASURER
3530 S WOODLAND CT
NEW BERLIN WI 53146

Officer/Director/Trustee Three

DAVID BEDNARSKI
VICE PRESIDENT
21725 W ANN LOUISE CT
NEW BERLIN WI 53146

Officer/Director/Trustee Four

JOLENE MELIUS
SECRETARY
15950 W CYNTHIA DRIVE
NEW BERLIN WI 53146

Officer/Director/Trustee Five

MARIO DELUCA
DIRECTOR
1400 S CARRIAGE LANE APT 5
NEW BERLIN WI 53151

Organization’s website HTTP://WWW.NBWYOUTHFOOTBALL.COM/
Organization’s email NBWYFC.TREASURER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2000
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N65 - Football Clubs, Leagues
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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