FORM 1023-EZ for CUBBAGE CHAPEL CEMETERY ASSOCIATION

Field Data
EIN 47-4175795
Case Number EO-2018320-000098
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CUBBAGE CHAPEL CEMETERY ASSOCIATION
Organization’s Mailing Address 5092 HOTZE RD
City SALEM
State IL
ZIP 62881
Accounting period End 12
Primary contact name DOROTHY BRUCE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LOYD MAXEY
PRESIDENT
5339 MAXEY RD
SALEM IL 62881

Officer/Director/Trustee Two

CHERYL KELL
VICE PRESIDENT
5300 WOODARD SCHOOL RD
SALEM IL 62881

Officer/Director/Trustee Three

DOROTHY BRUCE
SECRETARY
5072 HOTZE RD
SALEM IL 62881

Officer/Director/Trustee Four

CURTIS PIPER
TREASURER
225 CIRCLE DR
SALEM IL 62881

Officer/Director/Trustee Five

LARRY CLARK
DIRECTOR
4908 BECKWOOD LN
SALEM IL 62881

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/8/15
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y50 - Cemeteries, Burial Services
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 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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DOROTHY BRUCE
Signature Title SECRETARY
Signature Date 11/14/18

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