FORM 1023-EZ for CARSONS TAVERN FOUNDATION INC

Field Data
EIN 87-2446431
Case Number EO-2021256-000736
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CARSONS TAVERN FOUNDATION INC
Organization’s Mailing Address 2883 SE OCEAN BLVD
City STUART
State FL
ZIP 34996
Accounting period End 12
Primary contact name WILLIAM PEMBROKE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARSON NOVINS
PRESIDENT
4590 SANDPEBBLE TRACE UNIT 204
STUART FL 34996

Officer/Director/Trustee Two

BETH NOVINS
DIRECTOR
2675 NW FLORIDA AVE
STUART FL 34994

Officer/Director/Trustee Three

JEFFREY HARTT
DIRECTOR
5544 NE GULFSTREAM WAY
STUART FL 34996

Officer/Director/Trustee Four

WILLIAM CONNELLY III
DIRECTOR
12735 SE OLD CYPRESS DRIVE
HOBE SOUND FL 33455

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/31/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L99 - Housing, Shelter N.E.C.
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 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 CARSON NOVINS
Signature Title PRESIDENT
Signature Date 9/11/2021

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