FORM 1023-EZ for LAKE SENIOR GAMES INC

Field Data
EIN 46-3416297
Case Number EO-2015334-000111
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE SENIOR GAMES INC
Organization’s Mailing Address 17307 PAGONIA ROAD SUITE 105
City CLERMONT
State FL
ZIP 34711
Accounting period End 12
Primary contact name GARY PERIGO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY PERIGO
EXECUTIVE DIRECTOR
17307 PAGONIA ROAD SUITE 105
CLERMONT FL 34711

Officer/Director/Trustee Two

JOSEPH STEED
DIRECTOR
17307 PAGONIA ROAD SUITE 105
CLERMONT FL 34711

Officer/Director/Trustee Three

WAYNE ALBERT
DIRECTOR
17307 PAGONIA ROAD SUITE105
CLERMONT FL 34711

Organization’s website WWW.LAKESENIORGAMES.COM
Organization’s email LAKESENIORGAMES@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N70 - Amateur Sports Competitions
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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