FORM 1023-EZ for SOUTHERN SHOCKERS

Field Data
EIN 27-4555095
Case Number EO-2015086-000453
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SOUTHERN SHOCKERS
Organization’s Mailing Address 9161 SW LIPE RD
City ARCADIA
State FL
ZIP 34269
Accounting period End 12
Primary contact name KEITH WALLACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TOM LIPE
PRESIDENT
9161 SW LIPE RD
ARCADIA FL 34269

Officer/Director/Trustee Two

KEITH WALLACE
DIRECTOR
PO BOX 110092
LAKEWOOD RANCH FL 34211

Officer/Director/Trustee Three

KOLBY LIPE
SECRETARY
9161 SW LIPE RD
ARCADIA FL 34269

Officer/Director/Trustee Four

JASON TEST
TREASURER
204 S MAIN AVE 128
LAKE PLACID FL 33852

Officer/Director/Trustee Five

TODD FAIRCLOTH
OFFICER
6001 ELM
SEBRING FL 33875

Organization’s website WWW.LEAGUELINEUP.COM/SOUTHERNSHOCKERS
Organization’s email SHOCKERSTOM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/15/2011
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N63 - Baseball, Softball
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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