FORM 1023-EZ for FISH LOAVES INC

Field Data
EIN 90-0475776
Case Number EO-2017248-000382
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FISH LOAVES INC
Organization’s Mailing Address 24 MAGNOLIA CT
City FREEPORT
State FL
ZIP 32439
Accounting period End 12
Primary contact name KRISTY C SHAFFER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES MULLINS
PRESIDENT
24 MAGNOLIA CT
FREEPORT FL 32439

Officer/Director/Trustee Two

PAUL GEARY
VICE PRESIDENT
12 TALON WAY
SANTA ROSA BEACH FL 32459

Officer/Director/Trustee Three

DORIS ROGERS
TEASURER
195-180 CASSINE GARDEN CT
SANTA ROSA BEACH FL 32459

Officer/Director/Trustee Four

KATHLEEN CORNELIUSON
SECRETARY
24 MAGNOLIA CT
FREEPORT FL 32439

Officer/Director/Trustee Five

VIVIAN GEARY
DIRECTOR
12 TALON WAY
GEARY FL 32439

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/1/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 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
Signature Title
Signature Date

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