FORM 1023-EZ for CENTRAL PA KHAOS

Field Data
EIN 47-5022781
Case Number EO-2016328-000082
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTRAL PA KHAOS
Organization’s Mailing Address 1643 CHURCHES RD
City LEWISBURG
State PA
ZIP 17837
Accounting period End 7
Primary contact name LACEY DUPERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT SHOWERS
PRESIDENT
1643 CHURCHES RD
LEWISBURG PA 17837

Officer/Director/Trustee Two

TANYA SCHREFFLER
VICE PRESIDENT
1422 FAIRVIEW RD
MCCLURE PA 17841

Officer/Director/Trustee Three

LACEY DUPERT
SECRETARY
409 E MARKET ST
FREEBURG PA 17827

Officer/Director/Trustee Four

DENISE SHUPP
12U TREASURER
585 HETRICK RIDGE RD
BEAVERTWON PA 17813

Officer/Director/Trustee Five

JUSTINE SHOWERS
10U TREASURER
178 WALLS RD
MIFFLINBURG PA 17844

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/10/2015
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N63 - Baseball, Softball
Organization’s purpose Charitable: No
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 Yes
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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