FORM 1023-EZ for ST PETERSBURG LODGE 109 INC

Field Data
EIN 86-2468822
Case Number EO-2021103-000547
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ST PETERSBURG LODGE 109 INC
Organization’s Mailing Address 3130 18TH AVE S
City ST PETERSBURG
State FL
ZIP 33712
Accounting period End 12
Primary contact name ALVIN WALKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALVIN WALKER
VP
11202 SCOTCH WOOD DRIVE
RIVERVIEW FL 33597

Officer/Director/Trustee Two

BRENT BROWN
PRESIDENT
6800 16TH WAY S
ST PETERSBURG FL 33712

Officer/Director/Trustee Three

JOSIAH GUMBS
SECRETARY
1322 ALHAMBRA WAY SOUTH
ST PETERSBURG FL 33705

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S82 - Men's Service Clubs
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 Yes
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 Yes
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 Yes
Correctness Declaration Yes
Signature Name ALVIN WALKER
Signature Title VP
Signature Date 4/8/2021

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