FORM 1023-EZ for DALTON SERENITY CLUB INC

Field Data
EIN 58-2017100
Case Number EO-2019318-000148
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DALTON SERENITY CLUB INC
Organization’s Mailing Address 108 S THORNTON AVE
City DALTON
State GA
ZIP 30720
Accounting period End 12
Primary contact name TERRY MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY MILLER
CFO
P O BOX 668
DALTON GA 30720

Officer/Director/Trustee Two

EUGENE LAWSON
CEO
180 LOVEBRIDGE DRIVE SE
CALHOUN GA 30701

Officer/Director/Trustee Three

STEWART COFIELD
SECRETARY
909 MCCAMY ROAD
CHATSWORTH GA 30705

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/21/92
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
Correctness Declaration Yes
Signature Name TERRY MILLER
Signature Title CFO
Signature Date 11/12/19

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