FORM 1023-EZ for NEW LIFE STATION

Field Data
EIN 81-2677868
Case Number EO-2016193-000617
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NEW LIFE STATION
Organization’s Mailing Address 124 CONKLIN AVE
City BINGHAMTON
State NY
ZIP 13903
Accounting period End 12
Primary contact name ROBERT C KLOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT C KLOCK
PRESIDENT, CHAIRPERSON
746 CONKLIN RD
BINGHAMTON NY

Officer/Director/Trustee Two

DOROTHY PIERCE
TREASURER
2421 WEST MAIN ST
WHITNEY POINT NY 13862

Officer/Director/Trustee Three

GARY MICHAEL PUTNEY
VICE PRESIDENT
1890 COLESVILLE RD
HARPURSVILLE NY 13787

Officer/Director/Trustee Four

JIANZHONG BRONSON
DIRECTOR
29 DEPOT ST
PORT CRANE NY 13833

Officer/Director/Trustee Five

CURT CARTER
DIRECTOR
90 SOUTHWICK HILL RD
CANDOR NY 13743

Organization’s website N/A
Organization’s email BOBK4CR@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P72 - Half-Way House (Short-Term Residential Care)
Organization’s purpose Charitable: Yes
Religious: Yes
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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