FORM 1023-EZ for CHACONIA SOCCER CLUB INC

Field Data
EIN 46-3250576
Case Number EO-2017067-000520
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHACONIA SOCCER CLUB INC
Organization’s Mailing Address 10 BEACH LANE
City MEDFORD
State NY
ZIP 11763
Accounting period End 12
Primary contact name ANTHONY HENRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTHONY HENRY
PRESIDENT
10 BEACH LANE
MEDFORD NY 11763

Officer/Director/Trustee Two

NIGEL HENRY
VICE PRESIDENT
571 PORTLAND AVENUE
BALDWIN NY 11510

Officer/Director/Trustee Three

JO-ANN HENRY
SECRETARY
10 BEACH LANE
MEDFORD NY 11763

Officer/Director/Trustee Four

NIGEL HENRY
TREASURER
571 PORTLAND AVENUE
BALDWIN NY 11510

Officer/Director/Trustee Five

ANDY AMMON
TRUSTEE
140-21 180TH STREET
SPRINGFIELD GARDENS NY 11434

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/2013
Organization Incorporation State NY
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: 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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