FORM 1023-EZ for CLAY COUNTY SENIOR ADULT ADVOCACY COUNCIL INC

Field Data
EIN 59-3751734
Case Number EO-2019192-000350
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAY COUNTY SENIOR ADULT ADVOCACY COUNCIL INC
Organization’s Mailing Address P O BOX 8779
City FLEMING ISLAND
State FL
ZIP 32006
Accounting period End 12
Primary contact name JAMI KELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMI KELLY
PRESIDENT
1758 PICKWICK PLACE
FLEMING ISLAND FL 32003

Officer/Director/Trustee Two

ERNIE COHEN
VICE PRESIDENT
1726 KINGSLEY AVE UNIT 2
ORANGE PARK FL 32073

Officer/Director/Trustee Three

HEIDI FORTHSYE
SECRETARY
745 BLANDING BLVD
ORANGE PARK FL 32065

Officer/Director/Trustee Four

AMANDA KING
TEASURER
3651 US HWY 17
FLEMING ISLAND FL 32003

Organization’s website
Organization’s email CCSAAC2018@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/3/01
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAMI KELLY
Signature Title PRESIDENT
Signature Date 7/9/19

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