FORM 1023-EZ for THE LLOYD D SHIRLEY A TUBBS FAMILYCHARITABLE FOUNDATION

Field Data
EIN 81-6999520
Case Number EO-2016364-000119
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE LLOYD D SHIRLEY A TUBBS FAMILYCHARITABLE FOUNDATION
Organization’s Mailing Address 1424 W BUFFALO RD
City LONG ISLAND
State KS
ZIP 67647
Accounting period End 12
Primary contact name LLOYD OR SHIRLEY TUBBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LLOYD TUBBS
TRUSTEE
1424 W BUFFALO RD
LONG ISLAND KS 67647

Officer/Director/Trustee Two

SHIRLEY TUBBS
TRUSTEE
1424 W BUFFALO RD
LONG ISLAND KS 67647

Officer/Director/Trustee Three

GAIL TUBBS
TRUSTEE
1424 W BUFFALO RD
LONG ISLAND KS 67647

Organization’s website
Organization’s email
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/2016
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P43 - Family Violence Shelters, Services
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 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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