FORM 1023-EZ for PETAGON INTERNATIONAL INCORPORATED

Field Data
EIN 46-5298454
Case Number EO-2016190-000190
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PETAGON INTERNATIONAL INCORPORATED
Organization’s Mailing Address 83 SWIFT STREET
City QUINCY
State FL
ZIP 32351
Accounting period End 4
Primary contact name JAN SHEKITKA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAN SHEKITKA
TREASURER
83 SWIFT STREET
QUINCY FL 32351

Officer/Director/Trustee Two

AMELIA SHEKITKA
PRESIDENT
83 SWIFT STREET
QUINCY FL 32351

Officer/Director/Trustee Three

BRIAN DURHAM
SECRETARY
83 SWIFT ST
QUINCY FL 32351

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/4/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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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