FORM 1023-EZ for EAST TEXAS BLACK GUMBO RETIEVER CLUB

Field Data
EIN 47-2373078
Case Number EO-2017111-000270
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EAST TEXAS BLACK GUMBO RETIEVER CLUB
Organization’s Mailing Address 542 ACR 1370
City PALESTINE
State TX
ZIP 75801
Accounting period End 5
Primary contact name JOE TUBBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAWN SEVERN
PRESIDENT
101 LAZY OAKS APT 804
LUFKIN TX 75901

Officer/Director/Trustee Two

JAY HERRINGTON
VICE PRESIDENT
100 MEDICAL DR
PLESTINE TX 75801

Officer/Director/Trustee Three

JOE TUBBS
TREASURER
542 ACR 1370
PALESTINE TX 75801

Officer/Director/Trustee Four

SHAWN SEVERN
SECRETARY
101LAZY OAKS APT 804
LUFKIN TX 75901

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/14/2014
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D61 - Animal Training, Behavior
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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