FORM 1023-EZ for JORDAN LAKE FUTBOL CLUB

Field Data
EIN 82-4520888
Case Number EO-2018060-000179
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JORDAN LAKE FUTBOL CLUB
Organization’s Mailing Address 8713 PIERCE OLIVE RD
City APEX
State NC
ZIP 27539
Accounting period End 12
Primary contact name SCOTT WALLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT WALLER
SECRETARY
5501 LAKE EDGE DR
HOLLY SPRINGS NC 27540

Officer/Director/Trustee Two

CHAD POPROCKI
PRESIDENT
8713 PIERCE OLIVE RD
APEX NC 27539

Officer/Director/Trustee Three

MELISSA WALLER
DIRECTOR
5501 LAKE EDGE DRIVE
HOLLY SPRINGS NC 27540

Officer/Director/Trustee Four

DIANE DEMOURA
DIRECTOR
1891 PENNINO WAY
APEX NC 27502

Officer/Director/Trustee Five

JEFF WARD
DIRECTOR
6508 WILSHIRE DR
FUQUAY VARINA NC 27526

Organization’s website HTTP://JORDANLAKEFC.COM
Organization’s email JSW1969@ME.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/18
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 SCOTT WALLER
Signature Title SECRETARY
Signature Date 2/27/18

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