FORM 1023-EZ for PERRY COUNTY SPORTSMAN CLUB

Field Data
EIN 37-1090666
Case Number EO-2015251-000338
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PERRY COUNTY SPORTSMAN CLUB
Organization’s Mailing Address 6155 WHITE WALNUT ROAD
City PINCKNEYVILLE
State IL
ZIP 62274
Accounting period End 12
Primary contact name MARY ANN JAUSEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALAN BRUNS
PRESIDENT
5892 STATE ROUTE 127
PINCKNEYVILLE IL 62274

Officer/Director/Trustee Two

MARY ANN JAUSEL
SECRETARY/TREASURER
PO BOX 472
PINCKNEYVILLE IL 62274

Officer/Director/Trustee Three

ANTHONY KELLERMAN
VICE-PRESIDENT
4625 PRIVATE ROAD 20
PINCKNEYVILLE IL 62274

Officer/Director/Trustee Four

JAMIE KELLERMAN
TRUSTEE
5442 CROSS CHURCH ROAD
PINCKNEYVILLE IL 62274

Officer/Director/Trustee Five

VERNON JAUSEL
TRUSTEE
PO BOX 472
PINCKNEYVILLE IL 62274

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/1979
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C11 - Single Organization Support
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 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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