FORM 1023-EZ for THE SOURCE YOUTH CENTER

Field Data
EIN 47-3620238
Case Number EO-2015114-000263
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE SOURCE YOUTH CENTER
Organization’s Mailing Address 7188 RAPID RIVER DR N
City JACKSONVILLE
State FL
ZIP 32219
Accounting period End 12
Primary contact name KATHY SENIOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KATHY SENIOR
PRESIDENT
7188 RAPID RIVER DR N
JACKSONVILLE FL 32219

Officer/Director/Trustee Two

SHANA INGRAM
VP
11448 TORI LANE
JACKSONVILLE FL 32218

Officer/Director/Trustee Three

SHANNON INGRAM
VP
3952 ATLANTIC BLVD UNIT G-4
JACKSONVILLE FL 32207

Officer/Director/Trustee Four

DONALD JACKSONVILLE
VP
7188 RAPID RIVER DR N
JACKSONVILLE FL 32219

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/2014
Organization Incorporation State FL
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: No
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 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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