FORM 1023-EZ for FLAGLER PHENOMS

Field Data
EIN 82-2225967
Case Number EO-2017276-000167
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FLAGLER PHENOMS
Organization’s Mailing Address 67 ZEBULAHS TRAIL
City PALM COAST
State FL
ZIP 32164
Accounting period End 12
Primary contact name JAMES JIVIDEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STEVE VAN DEMARK
PRESIDENT
22 RAEMONT LANE
PALM COAST FL 32164

Officer/Director/Trustee Two

ROB KRIEGER
SECRETARY
24 ROLLINS LANE
PALM COAST FL 32164

Officer/Director/Trustee Three

JAMES JIVIDEN
TREASURER
67 ZEBULAHS TRAIL
PALM COAST FL 32164

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N60 - Amateur Sports Clubs, Leagues, N.E.C.
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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