FORM 1023-EZ for ST ROSE BLUE AND GOLD FUND INC

Field Data
EIN 82-1354195
Case Number EO-2017171-000331
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ST ROSE BLUE AND GOLD FUND INC
Organization’s Mailing Address 11 CLAREMONT DRIVE
City MAPLEWOOD
State NJ
ZIP 07040
Accounting period End 12
Primary contact name BRIAN KOSTKA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIAN KOSTKA
PRESIDENT
11 CLAREMONT DRIVE
MAPLEWOOD NJ 07040

Officer/Director/Trustee Two

JOSEPH ZABIK
OFFICER
31 CURTISS PLACE
MAPLEWOOD NJ 07040

Officer/Director/Trustee Three

MICHAEL RYAN
OFFICER
81 DURAND ROAD
MAPLEWOOD NJ 07040

Officer/Director/Trustee Four

STEPHEN MAY
OFFICER
114 SOUTH WYOMING AVENUE
SOUTH ORANGE NJ 07079

Officer/Director/Trustee Five

GLENN MATTSON
OFFICER
6 LEWIS DRIVE
MAPLEWOOD NJ 07040

Organization’s website
Organization’s email SRLABLUEANDGOLD@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/2017
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
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 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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