FORM 1023-EZ for RJS DINER INC

Field Data
EIN 47-2671263
Case Number EO-2016060-000243
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RJS DINER INC
Organization’s Mailing Address 3465 PHILLIPS HWY 816
City JACKSONVILLE
State FL
ZIP 32207-5658
Accounting period End 12
Primary contact name ROBERT E JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT E JOHNSON
CHIEF EXECUTIVE DIRECTOR
3465 PHILLIPS HWY 816
JACKSONVILLE FL 32207-5658

Officer/Director/Trustee Two

JUAREZ DESMUKES
ASSISTANT DIRECTOR
84 Q STREET SW APT 1
WASHINGTON DC 20024

Officer/Director/Trustee Three

KIM CROCKETT
SECRETARY
6308 BONDY ROAD
JACKSONVILLE FL 32210

Officer/Director/Trustee Four

PATRICIA FREEMAN
DIRECTOR
465 SALISBURY ROAD SOUTH
JACKSONVILLE FL 32256

Organization’s website
Organization’s email RJS.DINER72@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/29/2014
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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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