FORM 1023-EZ for SERCE DLA PSA

Field Data
EIN 83-4053602
Case Number EO-2019233-000053
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SERCE DLA PSA
Organization’s Mailing Address 307 E CHERRY COVE LN
City ROUND LAKE BEACH
State IL
ZIP 60073
Accounting period End 12
Primary contact name MARIOLA PTASINSKI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARIOLA PTASINSKA
PRESIDENT
307 E CHERRY COVE
ROUND LAKE BEACH IL 60073

Officer/Director/Trustee Two

VIOLETA MAZUR
VICE-PRESIDENT
3237 VICTORIAN LN
LONG GROVE IL 60047

Officer/Director/Trustee Three

KATARZYNA ZIMOLAG
SECRETARY
4435 BAYSIDE CIR
HOFFMAN ESTATES IL 60019

Officer/Director/Trustee Four

EWA JAKUBIK
TREASURY
7441 W LAWLER
NILES IL 60714

Organization’s website SERCEDLAPSA@FB
Organization’s email SERCEDLAPSA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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 Yes
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 EWA JAKUBIK
Signature Title TREASURY
Signature Date 8/17/19

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