FORM 1023-EZ for LEBANON LODGE TEMPLE ASSOCIATION INC

Field Data
EIN 83-1472822
Case Number EO-2018221-000279
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEBANON LODGE TEMPLE ASSOCIATION INC
Organization’s Mailing Address 107-51 GUY R BREWER BLVD
City JAMAICA
State NY
ZIP 11433
Accounting period End 12
Primary contact name SHANELL ROBINSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GARY VAUGHN
PRESIDENT
117-23 229TH STREET
CAMBRIA HEIGHTS NY 11411

Officer/Director/Trustee Two

RICHARD PROVIDENCE
VICE PRESIDENT
59 FOREST ROAD
VALLEY STREAM NY 11581

Officer/Director/Trustee Three

JEAN JOSEPH
TREASURER
194 BELMONT AVENUE
ELMONT NY 11003

Officer/Director/Trustee Four

NORRIS JOHNS
SECRETARY
172 AMELIA ROAD
JAMAICA NY 11434

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/18
Organization Incorporation State NY
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: Yes
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 GARY VAUGHN
Signature Title PRESIDENT
Signature Date 8/7/18

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