FORM 1023-EZ for DEVON COUNTRY CLUB

Field Data
EIN 81-2264299
Case Number EO-2018186-000160
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DEVON COUNTRY CLUB
Organization’s Mailing Address 4600 MILLERSVILLE ROAD
City INDIANAPOLIS
State IN
ZIP 46220
Accounting period End 12
Primary contact name LISA MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH BALTZ
PRESIDENT
7418 GLENVIEW DRIVE EAST
INDIANAPOLIS IN 46250

Officer/Director/Trustee Two

MAC MARTIN
VICE PRESIDENT
5752 EAST FALL CREEK PARKWAY NORTH
INDIANAPOLIS IN 46226

Officer/Director/Trustee Three

CAM ELLIS
TREASURER
6284 RUCKER RD SUITE A
INDIANAPOLIS IN 46220

Organization’s website DEVONCLUB.COM
Organization’s email DEVONCOUNTRYCLUB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/2/18
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
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 CAM ELLIS
Signature Title TREASURER
Signature Date 7/2/18

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