FORM 1023-EZ for JACKSON LIFE SERVICES INC

Field Data
EIN 82-4915815
Case Number EO-2018107-000199
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACKSON LIFE SERVICES INC
Organization’s Mailing Address 1103 N MACEDONIA AVE
City MUNCIE
State IN
ZIP 47303
Accounting period End 12
Primary contact name PASTOR ROBERT SCAIFE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIE GOHLAR
PRESIDENT
900 E KIRBY AVE
MUNCIE IN 47303

Officer/Director/Trustee Two

HARRISON MARTIN
VICE PRESIDENT
1302 S PERSHING
MUNCIE IN 47302

Officer/Director/Trustee Three

KARLA MALLORY
SECRETARY
1510 N BURNS ST
MUNCIE IN 47303

Officer/Director/Trustee Four

CHANDRA FORD
TREASURER
5701 N CEDAR SPRINGS RD
MUNCIE IN 47304

Organization’s website
Organization’s email R0B_SCAIFE18@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/23/18
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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 WILLIE GOHLAR
Signature Title PRESIDENT
Signature Date 3/23/18

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