FORM 1023-EZ for CANCER JAM INC

Field Data
EIN 81-4095148
Case Number EO-2016287-000173
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CANCER JAM INC
Organization’s Mailing Address 18208 PRESTON RD STE D9184
City DALLAS
State TX
ZIP 75252
Accounting period End 12
Primary contact name ALEX HARGIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALEX HARGIS
DIRECTOR
2501 SHEPARD LN
CORINTH TX 76210

Officer/Director/Trustee Two

DUSTIN BLOCKER
DIRECTOR
4302 FAIRWAY DR
GRANBURY TX 76049

Officer/Director/Trustee Three

CHAD JONES
DIRECTOR
6906 BLESSING AVE
AUSTIN TX 78752

Organization’s website WWW.CANCERJAMTX.ORG
Organization’s email AHARGIS@CANCERJAMTX.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/3/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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 Yes
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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