FORM 1023-EZ for LIFE STORE FL CORP

Field Data
EIN 47-1980430
Case Number EO-2014276-000396
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE STORE FL CORP
Organization’s Mailing Address 542752 US HIGHWAY 1
City CALLAHAN
State FL
ZIP 32011
Accounting period End 12
Primary contact name DWAYNE KEELING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DWAYNE KEELING
OFFICER/DIRECTOR
45215 STRATTON ROAD
CALLAHAN FL 32011

Officer/Director/Trustee Two

TRAVIS KEELING
DIRECTOR
54062 LILLY COURT
CALLAHAN FL 32011

Officer/Director/Trustee Three

JESSIE NEWMAN III
DIRECTOR
7019 RIVERCREST DRIVE
JACKSONVILLE FL 32226

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 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
Signature Title
Signature Date

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