FORM 1023-EZ for KAPPA CHI SIGMA CHAPTER OF PHI BETASIGMA FRATERNITY INC

Field Data
EIN 46-2980182
Case Number EO-2017080-000220
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KAPPA CHI SIGMA CHAPTER OF PHI BETASIGMA FRATERNITY INC
Organization’s Mailing Address PO BOX 560083
City ROCKLEDGE
State FL
ZIP 32956
Accounting period End 12
Primary contact name RONALD MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMES JACKSON
CHAPTER PRESIDENT
237 JACARANDA AVENUE NW
PALM BAY FL 32907

Officer/Director/Trustee Two

RONALD MARTIN
CHAPTER VICE PRESIDENT
4919 BUTTONWOOD DRIVE
MELBOURNE FL 32940

Officer/Director/Trustee Three

JAMAR MOSLEY
CHAPTER SECRETARY
830 HARRIER AVENUE
SATELLITE BEACH FL 32937

Officer/Director/Trustee Four

BRANDON TOMPKINS
CHAPTER TREASURER
2121 GRAND TELON BOULEVARD
MELBOURNE FL 32935

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/14/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y42 - Domestic Fraternal Societies
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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