FORM 1023-EZ for MID-ATLANTIC CORNHOLE INC

Field Data
EIN 83-1995194
Case Number EO-2018290-000266
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MID-ATLANTIC CORNHOLE INC
Organization’s Mailing Address 8306 CHURCH POND RD
City FREDERICKSBURG
State VA
ZIP 22408
Accounting period End 12
Primary contact name HALEIGH WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ASHLEY JACOBS
TREASURER
8306 CHURCH POND RD
FREDERICKSBURG VA 22408

Officer/Director/Trustee Two

CURTIS KEARNS II
SECRETARY
8502 GLENMONT DR
FREDERICKSBURG VA 22407

Officer/Director/Trustee Three

SHAWN JACOBS
PRESIDENT
8306 CHURCH POND RD
FREDERICKSBURG VA 22408

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
Donation of funds Yes
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 SHAWN JACOBS
Signature Title PRESIDENT
Signature Date 10/15/18

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