| Entity Name: | CLAY COUNTY HABITAT FOR HUMANITY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 03 Feb 1977 (48 years ago) |
| Document Number: | 737994 |
| FEI/EIN Number | 591748850 |
| Address: | 1717 BLANDING BOULEVARD, MIDDLEBURG, FL, 32068, US |
| Mail Address: | P.O. BOX 240, ORANGE PARK, FL, 32067-0240, US |
| ZIP code: | 32068 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAX DEFERRED ANNUITY CLAY COUNTY HABITAT FOR HUMANITY INC. | 2012 | 591748850 | 2013-08-26 | CLAY COUNTY HABITAT FOR HUMANITY INC | 1 | |||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-08-26 |
| Name of individual signing | CAROLYN EDWARDS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 522292 |
| Sponsor’s telephone number | 9042827590 |
| Plan sponsor’s address | 1717 BLANDING BLVD., MIDDLEBURG, FL, 32068 |
Plan administrator’s name and address
| Administrator’s EIN | 591748850 |
| Plan administrator’s name | CLAY COUNTY HABITAT FOR HUMANITY INC |
| Plan administrator’s address | 1717 BLANDING BLVD., MIDDLEBURG, FL, 32068 |
| Administrator’s telephone number | 9042827590 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-22 |
| Name of individual signing | CAROLYN EDWARDS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 522292 |
| Sponsor’s telephone number | 9042827590 |
| Plan sponsor’s address | 1717 BLANDING BLVD., MIDDLEBURG, FL, 32068 |
Plan administrator’s name and address
| Administrator’s EIN | 571748850 |
| Plan administrator’s name | CLAY COUNTY HABITAT FOR HUMANITY, INC. |
| Plan administrator’s address | 1717 BLANDING BLVD., MIDDLEBURG, FL, 32068 |
| Administrator’s telephone number | 9042827590 |
Signature of
| Role | Plan administrator |
| Date | 2012-10-22 |
| Name of individual signing | CAROLYN EDWARDS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 624100 |
| Sponsor’s telephone number | 9042827590 |
| Plan sponsor’s address | 1717 BLANDING BLVD, MIDDLEBURG, FL, 32068 |
Plan administrator’s name and address
| Administrator’s EIN | 591748850 |
| Plan administrator’s name | CLAY COUNTY HABITAT FOR HUMANITY INC |
| Plan administrator’s address | 1717 BLANDING BLVD, MIDDLEBURG, FL, 32068 |
| Administrator’s telephone number | 9042827590 |
Signature of
| Role | Plan administrator |
| Date | 2010-10-14 |
| Name of individual signing | TRACY GRISSETT |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| EDWARDS CAROLYN | Agent | 1717 BLANDING BOULEVARD, MIDDLEBURG, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| EDWARDS CAROLYN | Executive Director | 1717 BLANDING BOULEVARD, MIDDLEBURG, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| Goble Gary | Vice President | 4000 Lake Crest Terrace, MIDDLEBURG, FL, 32068 |
| Name | Role | Address |
|---|---|---|
| Campbell John | Director | 2569 Ridgecrest Avenue, Orange Park, FL, 32065 |
| Baker Cliff | Director | 1796 Shoal Creek Circle, Green Cove Springs, FL, 32043 |
| Name | Role | Address |
|---|---|---|
| HARDIN CECILY | Secretary | 1472 KATHLEEN WAY, FLEMING ISLAND, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| Youngblood Mike | President | 128 Fairway Oaks Drive, Fleming Island, FL, 32003 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1988-02-24 | CLAY COUNTY HABITAT FOR HUMANITY, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
