FORM 1023-EZ for SCOTT HEBURN PRISON MINISTRY INC

Field Data
EIN 81-1817971
Case Number EO-2017065-000396
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SCOTT HEBURN PRISON MINISTRY INC
Organization’s Mailing Address 5640 159TH DR
City LIVE OAK
State FL
ZIP 32060
Accounting period End 12
Primary contact name CINDY HEBURN SECRETARY-TREASURER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SCOTT HEBURN
PRESIDENT
5640 159TH DR
LIVE OAK FL 32060

Officer/Director/Trustee Two

JIM FARABEE
VICE PRESIDENT
9794 116TH PLACE
LIVE OAK FL 32060

Officer/Director/Trustee Three

PAT RAULERSON
DIRECTOR
8611 187TH PLACE
LIVE OAK FL 32060

Officer/Director/Trustee Four

SUSAN FARABEE
DIRECTOR
9794 116TH PLACE
LIVE OAK FL 32060

Officer/Director/Trustee Five

CINDY HEBURN
SECRETARY TREASURER
5640 159TH DR
LIVE OAK FL 32060

Organization’s website SCOTTHEBURNPRISONMINISTRY.COM
Organization’s email SCOTTHEBURNPRISONMINISTRY@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/8/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Donation of funds Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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