FORM 1023-EZ for CLEBURNE COUNTY 18 AND UNDER FISHING CHAMPIONSHIP SCHOLARSHIP PROGRAM

Field Data
EIN 84-3993277
Case Number EO-2019354-000328
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLEBURNE COUNTY 18 AND UNDER FISHING CHAMPIONSHIP SCHOLARSHIP PROGRAM
Organization’s Mailing Address 2680 WILBURN RD
City HEBER SPRINGS
State AR
ZIP 72543
Accounting period End 12
Primary contact name SEAN BLACKBURN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SEAN BLACKBURN
PRESIDENT
2680 WILBURN RD
HEBER SPRINGS AR 72543

Officer/Director/Trustee Two

GWYNNE GOLDEN
VICE PRESIDENT
PO BOX 36
DRASCO AR 72530

Officer/Director/Trustee Three

LINDA FLETCHER
SECRETARY/TREASURER
4489 HEBER SPRINGS RD
IDA AR 72546

Officer/Director/Trustee Four

EVANGELINE STONE
DIRECTOR
1179 OLD HWY 25 N
TUMBLING SHOALS AR 72581

Officer/Director/Trustee Five

AMANDA BROGDON
DIRECTOR
405 MULBERRY COVE
HEBER SPRINGS AR 72543

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/6/2019
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 Yes
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 SEAN BLACKBURN
Signature Title PRESIDENT
Signature Date 12/18/2019

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