FORM 1023-EZ for PROJECT SELF RELIANCE

Field Data
EIN 84-3143424
Case Number EO-2019269-000146
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PROJECT SELF RELIANCE
Organization’s Mailing Address 10075 GATE PARKWAY NORTH 1710
City JACKSONVILLE
State FL
ZIP 32246-4418
Accounting period End 12
Primary contact name MICHAEL JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL JOHNSON
PRESIDENT
10075 GATE PARKWAY NORTH 1710
JACKSONVILLE FL 32246-4418

Officer/Director/Trustee Two

DEBBIE DAVID
TREASURER
8800 HAZELHURST DRIVE
AUSTIN TX 78729-3784

Officer/Director/Trustee Three

STEVEN FARAGALLA
SECRETARY
3920 SW 20TH AVENUE 1309
GAINESVILLE FL 32607-4420

Organization’s website NA
Organization’s email PSR98@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code J30 - Vocational Rehabilitation
Organization’s purpose Charitable: Yes
Religious: No
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 Yes
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 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 MICHAEL JOHNSON
Signature Title PRESIDENT
Signature Date 9/24/19

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