FORM 1023-EZ for HUMPHREYS COUNTY SOCCER

Field Data
EIN 81-3472212
Case Number EO-2016251-000453
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HUMPHREYS COUNTY SOCCER
Organization’s Mailing Address PO BOX 793
City WAVERLY
State TN
ZIP 37185
Accounting period End 12
Primary contact name JENNIFER HEDIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY O MARY
PRESIDENT
456 POWERS BLVD
WAVERLY TN 37185

Officer/Director/Trustee Two

JENNIFER HEDIN
SECRETARY/TREASURER
380 WILLIAMS HOLLOW RD
MC EWEN TN 37101-4910

Organization’s website WWW.HUMPHREYSCOUNTYSOCCER.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2016
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N64 - Soccer Clubs, Leagues
Organization’s purpose Charitable: No
Religious: No
Educational: No
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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