FORM 1023-EZ for 10-42 CORPORATION

Field Data
EIN 81-0971647
Case Number EO-2016062-000203
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 10-42 CORPORATION
Organization’s Mailing Address 2104 SW 75TH TERRACE
City GAINESVILLE
State FL
ZIP 32607
Accounting period End 3
Primary contact name SHONTA BERTZYK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIAR JALLAD
REGISTERED AGENT
2104 SW 75TH TERRACE
GAINESVILLE FL 32607

Officer/Director/Trustee Two

SHONTA BERTZYK
PRESIDENT
2616 NW 52ND AVE
GAINESVILLE FL 32605

Officer/Director/Trustee Three

ASHLEY DYKES
SECRETARY
3321 NW 41ST AVE
GAINESVILLE FL 32605

Officer/Director/Trustee Four

CARA HOPKINS
MEMBER
275 NW 238TH TERRACE
NEWBERRY FL 32669

Organization’s website WWW.ALACHUA1042.ORG
Organization’s email ALACHUA1042@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/19/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I60 - Law Enforcement Agencies (Police Departments)
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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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