FORM 1023-EZ for PATASKALA COMMUNITY OUTREACH

Field Data
EIN 81-4441376
Case Number EO-2017248-000430
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PATASKALA COMMUNITY OUTREACH
Organization’s Mailing Address 6368 SUMMIT RD SW
City PATASKALA
State OH
ZIP 43062
Accounting period End 12
Primary contact name JERIKA STROH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JERIKA STROH
CO-FOUNDER
6368 SUMMIT RD SW
PATASKALA OH 43062

Officer/Director/Trustee Two

HESCHEL ZUCKERMAN
CO-FOUNDER
6368 SUMMIT RD SW
PATASKALA OH 43062

Officer/Director/Trustee Three

264 OAK MEADOW DR 264 OAK MEADOW DR
CO-FOUNDER
264 OAK MEADOW DR
PATASKALA OH 43062

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/2/2017
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
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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