FORM 1023-EZ for CLEBURNE COUNTY SHOOTING SPORTS INC

Field Data
EIN 47-2327783
Case Number EO-2016244-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEBURNE COUNTY SHOOTING SPORTS INC
Organization’s Mailing Address 4010 LIBBY ROAD
City HEBER SPRINGS
State AR
ZIP 72543
Accounting period End 9
Primary contact name MELINDA WORTHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CODY SAMPLE
CHAIRMAN
117 CENTERVIEW CIR
SEARCY AR 72143-9481

Officer/Director/Trustee Two

DAVID STOGSDILL
VICE CHAIRMAN
1007 SECOND ST
PANGBURN AR 72121

Officer/Director/Trustee Three

TERESA PHILLIPS
SECRETARY
5600 WILBURN RD
WILBURN AR 72179-9748

Officer/Director/Trustee Four

MELINDA WORTHAM
TREASURER
125 JAMES
QUITMAN AR 72131-9590

Officer/Director/Trustee Five

TERRY PHILLIPS
DIRECTOR
5600 WILBURN RD
WILBURN AR 72179-9748

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/29/2014
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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
Signature Title
Signature Date

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