FORM 1023-EZ for POLK COUNTY BULLY PROJECT

Field Data
EIN 84-2316936
Case Number EO-2019241-000341
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POLK COUNTY BULLY PROJECT
Organization’s Mailing Address 2856 CARRIE LANE
City LAKELAND
State FL
ZIP 33812
Accounting period End 12
Primary contact name SHANNON MEDINA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHANNON MEDINA
PRESIDENT
2856 CARRIE LANE
LAKELAND FL 33812

Officer/Director/Trustee Two

ANGELA LORIO
V. PRESIDENT
2232 JONILA AVE
LAKELAND FL 33083

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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 SHANNON MEDINA
Signature Title PRESIDENT
Signature Date 8/27/19

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