FORM 1023-EZ for CLERMONT COMMUNITY CLUB

Field Data
EIN 42-1301827
Case Number EO-2021165-000267
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLERMONT COMMUNITY CLUB
Organization’s Mailing Address PO BOX 195
City ELGIN
State IA
ZIP 52141
Accounting period End 12
Primary contact name JEREMIAH WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MIKE ALEXANDER
INCORPRATOR
60 STONE STREET
CLERMONT IA 52135

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/2021
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 Yes
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 MIKE ALEXANDER
Signature Title INCORPRATOR
Signature Date 6/10/2021

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