FORM 1023-EZ for LAKE 100 INC

Field Data
EIN 81-2118399
Case Number EO-2016130-000154
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE 100 INC
Organization’s Mailing Address 10400 COUNTY ROAD 48
City HOWEY IN THE HILLS
State FL
ZIP 34737-3000
Accounting period End 12
Primary contact name KASEY KESSELRING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KASEY KESSELRING
PRESIDENT
17235 7TH STREET
MONTVERDE FL 34756-3210

Officer/Director/Trustee Two

BUD BEUCHER
VICE PRESIDENT
10400 COUNTY ROAD 48
HOWEY IN THE HILLS FL 34737-3000

Officer/Director/Trustee Three

RICH KELLY
SECRETARY
305 S CANAL STREET
LEESBURG FL 34748-5903

Officer/Director/Trustee Four

MIKE MASON
TREASURER
3606 PARKWAY BOULEVARD
LEESBURG FL 34748-9744

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/18/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S30 - Economic Development
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 Yes
One Third Support Gifts No
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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