FORM 1023-EZ for CASEY SERVICE CLUB

Field Data
EIN 83-0572414
Case Number EO-2018142-000128
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CASEY SERVICE CLUB
Organization’s Mailing Address 502 ANTIQUE COUNTRY DRIVE
City CASEY
State IA
ZIP 50048
Accounting period End 12
Primary contact name CORRINE PALMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NITA FAGAN
PRESIDENT, DIRECTOR
PO BOX 36
CASEY IA 50048

Officer/Director/Trustee Two

JUDY WEDEMEYER
PRESIDENT, DIRECTOR
PO BOX 36
CASEY IA 50048

Officer/Director/Trustee Three

BRET WEDEMEYER
TREASURER, DIRECTOR
PO BOX 36
CASEY IA 50048

Officer/Director/Trustee Four

CORRINE PALMER
SECRETARY, DIRECTOR
PO BOX 36
CASEY IA 50048

Officer/Director/Trustee Five

TERESA WILLIAMS
DIRECTOR
PO BOX 36
CASEY IA 50048

Organization’s website
Organization’s email CPALMER@ROLLINGHILLSBANK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/86
Organization Incorporation State IA
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: 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 CORRINE PALMER
Signature Title SECRETARY, DIRECTOR
Signature Date 5/18/18

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