FORM 1023-EZ for GIVE BACK NATION INC

Field Data
EIN 46-3821565
Case Number EO-2015040-000353
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GIVE BACK NATION INC
Organization’s Mailing Address 462 EQUINE DRIVE
City TARPON SPRINGS
State FL
ZIP 34688
Accounting period End 12
Primary contact name NICHOLAS GREGORY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

NICHOLAS GREGORY
TRUSTEE BOARD CHAIRMAN
462 EQUINE DRIVE
TARPON SPRINGS FL 34688

Officer/Director/Trustee Two

KYLE GREGORY
PRESIDENT
361 GOLDSTONE COURT
LAKE MARY FL 32746

Officer/Director/Trustee Three

ADAM WESTON
TREASURER
2375 POWERS STREET
PALM HARBOR FL 34683

Officer/Director/Trustee Four

GERRY NOWOTNY
SECRETARY
104 LOVELY LANE
AVON CT 06001

Officer/Director/Trustee Five

CONNIE DALTON
VICE-PRESIDENT
6401 E JACKSON STREET
MUNCIE FL 47303

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/7/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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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