FORM 1023-EZ for LEWIS COUNTY BAND BOOSTER

Field Data
EIN 62-1703886
Case Number EO-2015106-000260
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LEWIS COUNTY BAND BOOSTER
Organization’s Mailing Address PO BOX 32
City HOHENWALD
State TN
ZIP 38462
Accounting period End 4
Primary contact name CHARLES SHRODES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHANNON GLASS
PRESIDENT
227 MOUNT JOY ROAD
HAMPSHIRE TN 38461

Officer/Director/Trustee Two

CHARLES SHRODES
TREASURER
1032 CANE CREEK ROAD
HOHENWALD TN 38462

Officer/Director/Trustee Three

LORENDA ROCHELLE
SECRETARY
312 WEST 1ST AVE
HOHENWALD TN 38462

Officer/Director/Trustee Four

BRENDA MOMIER
SEARGENT AT ARMS
140 NEIGHBORS ROAD
HOHENWALD TN 38462

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/22/1997
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - 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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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