FORM 1023-EZ for LAKELAND LANCERS RUGBY CLUB

Field Data
EIN 82-1642343
Case Number EO-2019036-000054
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKELAND LANCERS RUGBY CLUB
Organization’s Mailing Address 116 BASSEDENA CIRCLE S
City LAKELAND
State FL
ZIP 33805
Accounting period End 8
Primary contact name JASON DARBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON DARBY
PRESIDENT
116 BASSEDENA CICLE S
LAKELAND FL 33801

Officer/Director/Trustee Two

JORDAN ARBUCKEL
VICE-PRESIDENT
309 EAST PARK STREET
LAKELAND FL 33803

Officer/Director/Trustee Three

SAREL BOTHA
TREASUER
5250 MIRIAM DRIVE
LAKELAND FL 33812

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/30/17
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
Organization’s purpose Charitable: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JASON DARBY
Signature Title PRESIDENT
Signature Date 1/21/19

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