FORM 1023-EZ for SUMMERTOWN DIXIE YOUTH

Field Data
EIN 47-4002142
Case Number EO-2015138-000301
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SUMMERTOWN DIXIE YOUTH
Organization’s Mailing Address PO BOX 193
City SUMMERTOWN
State TN
ZIP 38483
Accounting period End 12
Primary contact name JASON FRANCIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRIS LONG
PRESIDENT, DIRECTOR
101 MIDWAY RD
LAWRENCEBURG TN 38464

Officer/Director/Trustee Two

JASON FRANCIS
VICE PRESIDENT, DIRECTOR
571 NORTHPOINTE DR
SUMMERTOWN TN 38483

Officer/Director/Trustee Three

RETIKA PATTERSON
SECRETARY, DIRECTOR
221 GREENWOOD RD
LAWRENCEBURG TN 38464

Officer/Director/Trustee Four

AMANDA BURLESON
TREASURER, DIRECTOR
169 TAYLOR CIR
ETHRIDGE TN 38456

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2015
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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