FORM 1023-EZ for LIMESTONE JUNIOR SOCCER ASSOCIATION

Field Data
EIN 27-3728739
Case Number EO-2017271-000288
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIMESTONE JUNIOR SOCCER ASSOCIATION
Organization’s Mailing Address 4707 S LAFAYETTE
City BARTONVILLE
State IL
ZIP 61607-9292
Accounting period End 4
Primary contact name DENISE RYDER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NATHANIEL HURM
PRESIDENT
7908 W THORNRIDGE DR
MAPLETON IL 61547-9347

Officer/Director/Trustee Two

ANITA CAPE
VICE PRESIDENT
4707 S LAFAYETTE
BARTONVILLE IL 61607-9292

Officer/Director/Trustee Three

ROBERT FITCH
SECRETARY
1004 S JOHANSON RD
PEORIA IL 61607-1084

Officer/Director/Trustee Four

DENISE RYDER
TREASURER
7121 W LANCASTER RD
PEORIA IL 61607-9482

Officer/Director/Trustee Five

SHANNEN MEYERS
DIRECTOR
8629 W BARTELL
MAPLETON IL 61547-9659

Organization’s website LJSA.WEEBLY.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2010
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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