FORM 1023-EZ for COWBOY MAT CLUB

Field Data
EIN 93-0777610
Case Number EO-2018190-000492
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COWBOY MAT CLUB
Organization’s Mailing Address PO BOX 162
City PRINEVILLE
State OR
ZIP 97754
Accounting period End 3
Primary contact name KERYSA LAVEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KERYSA LAVEY
SECRETARY
2256 NE TIMBERWOLF LOOP
PRINEVILLE OR 97754

Officer/Director/Trustee Two

SHERRY LOCKLING
TREASURER
1193 NE HUDSPETH LN
PRINEVILLE OR 97754

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/77
Organization Incorporation State OR
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: 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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name KERYSA LAVEY
Signature Title SECRETARY
Signature Date 7/5/18

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