FORM 1023-EZ for JEFFERSON TEEN CONNECTION

Field Data
EIN 81-3882077
Case Number EO-2016265-000182
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON TEEN CONNECTION
Organization’s Mailing Address PO BOX 313
City JEFFERSON
State OR
ZIP 97352
Accounting period End 12
Primary contact name ANTHONY ROBERTS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTHONY ROBERTS
HEAD COORDINATOR
14822 JEFFERSON HWY 99E SPACE 20
JEFFERSON OR 97352

Officer/Director/Trustee Two

SHELLY HERRERA
COORDINATOR
3052 WINTEL ROAD S
JEFFERSON OR 97352

Organization’s website WWW.JEFFERSONTEENCONNECTION.COM
Organization’s email JTC@USA.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/25/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N50 - Recreational, Pleasure, or Social Club
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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