FORM 1023-EZ for BREAK THE MOLD

Field Data
EIN 61-1951461
Case Number EO-2019357-000446
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BREAK THE MOLD
Organization’s Mailing Address 16642 S 38TH ST
City PHOENIX
State AZ
ZIP 85048
Accounting period End 12
Primary contact name JENNIFER CLENNAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER CLENNAN
PRESIDENT
16642 S 38H ST
PHOENIX AZ 85048

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2019
Organization Incorporation State AZ
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: 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 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 JENNIFER CLENNAN
Signature Title PRESIDENT
Signature Date 12/20/2019

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