FORM 1023-EZ for CGMGA INC

Field Data
EIN 83-2981565
Case Number EO-2019063-000340
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CGMGA INC
Organization’s Mailing Address 8972 DOVE VALLEY WAY
City DAVENPORT
State FL
ZIP 33896
Accounting period End 12
Primary contact name JEREMY DERHAK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PETER LIGHTBURN
PRESIDENT
8926 DOVE VALLEY WAY
DAVENPORT FL 33896

Officer/Director/Trustee Two

JEREMY DERHAK
VICE PRESIDENT
8972 DOVE VALLEY WAY
DAVENPORT FL 33896

Officer/Director/Trustee Three

TODD YOUMANS
TREASURER
1416 PRO SHOP COURT
DAVENPORT FL 33896

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N6A - Golf
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 No
Correctness Declaration Yes
Signature Name JEREMY DERHAK
Signature Title VICE PRESIDENT
Signature Date 3/1/19

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