FORM 1023-EZ for J W HOLLEY YOUTH CLUB INC

Field Data
EIN 82-4338925
Case Number EO-2018176-000320
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name J W HOLLEY YOUTH CLUB INC
Organization’s Mailing Address PO BOX 5283
City SYLVESTER
State GA
ZIP 31791
Accounting period End 12
Primary contact name JOHN A NESMITH JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUDY HALL
CHAIRMAN
221 HUDSON ROAD
POULAN GA 31791

Officer/Director/Trustee Two

MICHAEL ALLEN
DIRECTOR
411 N JEFFERSON ST
SYLVESTER GA 31791

Officer/Director/Trustee Three

LARRY JAMES
DIRECTOR
307 WARREN DRIVE
SYLVESTER GA 31791

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 No
Correctness Declaration Yes
Signature Name JUDY HALL
Signature Title CHAIRMAN
Signature Date 6/21/18

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