FORM 1023-EZ for SSS ROBOTICS BOOSTER CLUB

Field Data
EIN 81-3021383
Case Number EO-2017053-000063
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SSS ROBOTICS BOOSTER CLUB
Organization’s Mailing Address 700 BOOKER DAIRY RD
City SMITHFIELD
State NC
ZIP 27577
Accounting period End 9
Primary contact name REV ALLEN BAKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REV ALLEN BAKER
PRESIDENT
4613 HARPER HOUSE RD
FOUR OAKS NC 27524

Officer/Director/Trustee Two

GEORGE STEWART 3RD
VICE PRESIDENT
392 BALD EAGLE LN
KENLY NC 27542

Officer/Director/Trustee Three

DEBRA TETREAULT
SECRETARY
376 CHRISTOPHER
CLAYTON NC 27520

Officer/Director/Trustee Four

DOTTIE BAKER
TREASURER
4613 HARPER HOUSE RD
FOUR OAKS NC 27524

Organization’s website
Organization’s email SSSROBOTICSBOOSTERCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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