FORM 1023-EZ for CLERMONT COMMUNITY CHAMPIONS FOUNDATION INC

Field Data
EIN 83-0998766
Case Number EO-2018234-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLERMONT COMMUNITY CHAMPIONS FOUNDATION INC
Organization’s Mailing Address 3600 S HIGHWAY 27
City CLERMONT
State FL
ZIP 34711
Accounting period End 10
Primary contact name JOSUE MARTINEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSUE MARTINEZ
PRESIDENT
3600 S HWY 27
CLERMONT FL 34711

Officer/Director/Trustee Two

MICHELLE ROGERS
SECRETARY
3600 S HWY 27
CLERMONT FL 34711

Officer/Director/Trustee Three

CYNDIA RIVERA
TREASURER
3600 S HWY 27
CLERMONT FL 34711

Officer/Director/Trustee Four

JUSTIN LATIMER
DIRECTOR
3600 S HWY 27
CLERMONT FL 34711

Organization’s website
Organization’s email JMARTINEZ@CLERMONTFL.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 No
Correctness Declaration Yes
Signature Name JOSUE MARTINEZ
Signature Title PRESIDENT
Signature Date 8/20/18

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