FORM 1023-EZ for GLEN FLORA COMMUNITY CLUB

Field Data
EIN 82-1933013
Case Number EO-2017174-000201
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GLEN FLORA COMMUNITY CLUB
Organization’s Mailing Address 5803 MILL STREET
City GLEN FLORA
State WI
ZIP 54526
Accounting period End 12
Primary contact name RUSSELL DUKERSCHEIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RUSSELL DUKERSCHEIN
TREASURER
N6248 DEERTAIL TRL
GLEN FLORA WI 54526

Officer/Director/Trustee Two

LAWRENCE DUKERSCHEIN
PRESIDENT
W3596 ARTISAN DR
GLEN FLORA WI 54526

Officer/Director/Trustee Three

GARY BENDIXEN
VICE PRESIDENT
W3595 SCHOOL RD
GLEN FLORA WI 54526

Officer/Director/Trustee Four

RON MOSER
SECRETARY
W4364 HWY 8
GLEN FLORA WI 54526

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2017
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 Yes
One Third Support Gifts No
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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