FORM 1023-EZ for SERENITY CLUB INC

Field Data
EIN 30-0056684
Case Number EO-2014245-000511
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SERENITY CLUB INC
Organization’s Mailing Address 206 SOUTH MAIN STREET
City ELIZABETHTOWN
State KY
ZIP 42701
Accounting period End 12
Primary contact name TERRY CRUSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TERRY CRUSE
PRESIDENT
46 HAMILTON HTS
HODGENVILLE KY 42748

Officer/Director/Trustee Two

ROBERT BAILEY
VICE PRESIDENT
126 S MAPLE
ELIZABETHTOWN KY 42701

Officer/Director/Trustee Three

DARLA SMITH
TREASURER
46 FOREST VIEW COURT
ELIZABETHTOWN KY 42701

Officer/Director/Trustee Four

DAVID SMITH
DIRECTOR
46 FORESTVIEW COURT
ELIZABETHTOWN KY 42701

Officer/Director/Trustee Five

BRIAN JONES
SECRETARY
PO BOX 1657
ELIZABETHTOWN KY 42702

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/2002
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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