FORM 1023-EZ for HICKMAN COUNTY SOCCER ALLIANCE

Field Data
EIN 47-1363963
Case Number EO-2016074-000175
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HICKMAN COUNTY SOCCER ALLIANCE
Organization’s Mailing Address 1863 HIGHWAY 100
City CENTERVILLE
State TN
ZIP 37033
Accounting period End 12
Primary contact name AMANDA MAYBERRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ERIC MAYBERRY
PRESIDENT
124 WEST END AVENUE
CENTERVILLE TN 37033

Officer/Director/Trustee Two

PAT SULLIVAN
VICE PRESIDENT
1217 ROSEWOOD DRIVE
CENTERVILLE TN 37033

Officer/Director/Trustee Three

AMANDA MAYBERRY
SECRETARY
124 WEST END AVENUE
CENTERVILLE TN 37033

Officer/Director/Trustee Four

CHRISTY MOSS
TREASURER
4243 MOSS HILL DRIVE
NUNNELLY TN 37137

Officer/Director/Trustee Five

ANGELA KISTLER
REGISTRAR
1329 ELLIOT ROAD
NUNNELLY TN 37137

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/14/2014
Organization Incorporation State TN
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: No
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
Signature Title
Signature Date

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