FORM 1023-EZ for FILLERS WORSHIP LLC

Field Data
EIN 84-3422524
Case Number EO-2019302-000222
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FILLERS WORSHIP LLC
Organization’s Mailing Address 2999 LONGBROOKE WAY
City CLEARWATER
State FL
ZIP 33760
Accounting period End 12
Primary contact name JEFFREY PEARSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEFFREY PEARSON
DIRECTOR
2999 LONGBROOKE WAY
CLEARWATER FL 33760

Officer/Director/Trustee Two

LAURA PEARSON
PRESIDENT
2999 LONGBROOKE WAY
CLEARWATER FL 33760

Officer/Director/Trustee Three

SANDRA YOUNG
TREASURER
10270 BAY HILLS DR
LARGO FL 33774

Officer/Director/Trustee Four

SUSAN ROBSON ROBSON
SECRETARTY
1240 15 CT SW
LARGO FL 33770

Officer/Director/Trustee Five

ALAN ROBSON
DIRECTOR
1240 15 CT SW
LARGO FL 33770

Organization’s website WWW.FILLERSWORSHIP.COM
Organization’s email KUDU.CALYX11@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 JEFFREY PEARSON
Signature Title DIRECTOR
Signature Date 10/27/19

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