FORM 1023-EZ for AMEZING ADULT DAY HEALTHCARE CENTERINC

Field Data
EIN 85-3037535
Case Number EO-2020262-000016
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AMEZING ADULT DAY HEALTHCARE CENTERINC
Organization’s Mailing Address 12456 WEEPING BRANCH CIRCLE
City JACKSONVILLE
State FL
ZIP 32218-9602
Accounting period End 12
Primary contact name DR MARLENE A GRIGGS-WARNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARLENE GRIGGS-WARNER
DIRECTOR
12456 WEEPING BRANCH CIR
JACKSONVILLE FL 32218-9602

Officer/Director/Trustee Two

ERROL WARNER
OFFICER
12456 WEEPING BRANCH CIR
JACKSONVILLE FL 32218-9602

Officer/Director/Trustee Three

CHARLES TABB
OFFICER
7013 BLACKARD RD
JACKSONVILLE FL 32211

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/6/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, Services
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 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 MARLENE GRIGGS-WARNER
Signature Title DIRECTOR
Signature Date 9/16/2020

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