FORM 1023-EZ for JACK WHITE CHARITY

Field Data
EIN 47-5180049
Case Number EO-2015279-000007
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACK WHITE CHARITY
Organization’s Mailing Address 429 W FRANKLIN ST
City LIBERTY
State MO
ZIP 64089
Accounting period End 12
Primary contact name ROY WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROY WHITE
PRESIDENT
429 W FRANKLIN ST
LIBERTY MO 64089

Officer/Director/Trustee Two

DAN JONES
VICE PRESIDENT
4601 NW 78TH TERR APT 154
KANSAS CITY MO 64151

Officer/Director/Trustee Three

DERRICK JOHNSON
TREASURER
9904 DRURY AVE
KANSAS CITY MO 64137

Officer/Director/Trustee Four

DALE CARPENTER
COMMITTEE CHAIR
6790 E CALLE LA PAZ APT 5202
TUCSON AZ 85715

Officer/Director/Trustee Five

RANDY WHITE
BOARD MEMBER
PO BOX 12615
KANSAS CITY MO 64116

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/30/2015
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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