FORM 1023-EZ for SANTA ROSA COUNTY KINSHIP CARE FAPASUPPORT GROUP

Field Data
EIN 81-3818096
Case Number EO-2017055-000705
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SANTA ROSA COUNTY KINSHIP CARE FAPASUPPORT GROUP
Organization’s Mailing Address 9948 PARKER LAKE CIRCLE
City NAVARRE
State FL
ZIP 32566-4803
Accounting period End 12
Primary contact name GERALD L WATERS SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GERALD WATERS
PRESIDENT
9948 PARKER LAKE CIRCLE
NAVARRE FL 32566-4803

Officer/Director/Trustee Two

TED FRAZIER
VICE PRESIDENT
5418 ALABAMA STREET
MILTON FL 32570

Officer/Director/Trustee Three

ANDREA WATERS
SECRETARY
9948 PARKER LAKE CIRCLE
NAVARRE FL 32566-4803

Organization’s website
Organization’s email GERALD.WATERS@MCHSI.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/12/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P32 - Foster Care
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 Yes
One Third Support Gifts No
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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