FORM 1023-EZ for CANCER TEES ME OFF

Field Data
EIN 47-4935452
Case Number EO-2018248-000018
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CANCER TEES ME OFF
Organization’s Mailing Address 117 MARSHALL AVENUE
City SANDUSKY
State OH
ZIP 44870
Accounting period End 12
Primary contact name SUSAN JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN JOHNSON
PRESIDENT
117 MARSHALL AVENUE
SANDUSKY OH 44870

Officer/Director/Trustee Two

LISA BLAKE
VICE PRESIDENT
1515 EAST PERKINS AVENUE
SANDUSKY OH 44870

Officer/Director/Trustee Three

TODD BILBREY
DIRECTOR
310 WEST CHERRY STREET
CLYDE OH 43410

Officer/Director/Trustee Four

TREVOR HAYBERGER
DIRECTOR
1602 CENTRAL AVENUE
SANDUSKY OH 44870

Officer/Director/Trustee Five

DELORA EVERSOLE
DIRECTOR
5614 DELORES DRIVE
CASTALIA OH 44824

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/23/15
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SUSAN JOHNSON
Signature Title PRESIDENT
Signature Date 8/31/18
EIN 47-4935452
Case Number EO-2015246-000349
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CANCER TEES ME OFF
Organization’s Mailing Address 117 MARSHALL AVENUE
City SANDUSKY
State OH
ZIP 44870
Accounting period End 12
Primary contact name SUSAN JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SUSAN JOHNSON
PRESIDENT, DIRECTOR
117 MARSHALL AVENUE17 MARSHALL AVEN
SANDUSKY OH 44870

Officer/Director/Trustee Two

LISA BLAKE
VICE PRESIDENT, DIRECTOR
4832 EAST WOODLAND DRIVE832 EAST WO
PORT CLINTON OH 43452-3146

Officer/Director/Trustee Three

KIM ELLIOTT
DIRECTOR
461 LONG RIDGE DRIVE
SEVEN HILLS OH 44131

Officer/Director/Trustee Four

TODD BILBREY
DIRECTOR
310 WEST CHERRY STREET
CLYDE OH 43410

Officer/Director/Trustee Five

TREVOR HAYBERGER
DIRECTOR
1602 CENTRAL AVENUE
SANDUSKY OH 44870

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/23/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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
Signature Title
Signature Date

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