FORM 1023-EZ for NAMI JACKSONVILLE FLORIDA INC

Field Data
EIN 59-2931035
Case Number EO-2015168-000132
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NAMI JACKSONVILLE FLORIDA INC
Organization’s Mailing Address PO BOX 24783
City JACKSONVILLE
State FL
ZIP 32241-4783
Accounting period End 12
Primary contact name HAYES BASFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HAYES BASFORD
PRESIDENT
4422 MCGIRTS BOULEVARD
JACKSONVILLE FL 32210-5943

Officer/Director/Trustee Two

EBONY BENJAMIN
VICE PRESIDENT
1445 NALDO AVENUE
JACKSONVILLE FL 32207-8604

Officer/Director/Trustee Three

MIKE FARMAND
TREASURER
4237 ATLANTIC BOULEVARD
JACKSONVILLE FL 32207-2040

Officer/Director/Trustee Four

INGE NEESE
SECRETARY
2834 RIPLEY AVENUE
JACKSONVILLE FL 32207-4615

Organization’s website JACKSONVILLE.NAMI.ORG
Organization’s email NAMIJAX@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/1988
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F80 - Mental Health Association, 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 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
Signature Title
Signature Date

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