FORM 1023-EZ for JOHNSON CITY LACROSSE INC

Field Data
EIN 82-5466706
Case Number EO-2018135-000106
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JOHNSON CITY LACROSSE INC
Organization’s Mailing Address 1906 SHERWOOD DR
City JOHNSON CITY
State TN
ZIP 37601
Accounting period End 12
Primary contact name R DAVID CROCKETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

R DAVID CROCKETT
PRESIDENT/TREASURER/DIRECTOR
1906 SHERWOOD DR
JOHNSON CITY TN 37601

Officer/Director/Trustee Two

APRIL CROCKETT
VP/SECRETARY/DIRECTOR
1906 SHERWOOD DR
JOHNSON CITY TN 37601

Officer/Director/Trustee Three

BEN CRAVEN
DIRECTOR
4 HANNAH CT
JOHNSON CITY TN 37615

Officer/Director/Trustee Four

TOM KRILEY
DIRECTOR
9545 HWY 421
SHADY VALLEY TN 37688

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/23/18
Organization Incorporation State TN
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 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 R DAVID CROCKETT
Signature Title PRESIDENT/TREASURER/DIRECTOR
Signature Date 5/9/18

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