FORM 1023-EZ for JEFFERSON COUNTY LIONS CLUB FOUNDATION INC

Field Data
EIN 81-2852412
Case Number EO-2016160-000293
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON COUNTY LIONS CLUB FOUNDATION INC
Organization’s Mailing Address 3366 NORTH SALT ROAD
City MONTICELLO
State FL
ZIP 32344
Accounting period End 6
Primary contact name JESSIE CARPENTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DEBBIE SNAP
PRESIDENT
3366 N SALT ROAD
MONTICELLO FL 32344

Officer/Director/Trustee Two

PAM BECK
VP
618 STILL RD
MONTICELLO FL 32344

Officer/Director/Trustee Three

JESSIE CARPENTER
SECRETARY/RESIDENT AGENT
9343 ROSE ROAD
TALLAHASSEE FL 32311

Officer/Director/Trustee Four

NORMAN CARPENTER
TREASURER
9343 ROSE ROAD
TALLAHASSEE FL 32311

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2007
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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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