FORM 1023-EZ for WEST LITTLE ROCK DOG PARK

Field Data
EIN 81-3850354
Case Number EO-2016260-000246
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WEST LITTLE ROCK DOG PARK
Organization’s Mailing Address 14125 COUNTY FARM ROAD
City LITTLE ROCK
State AR
ZIP 72223
Accounting period End 12
Primary contact name SUSIE JACOBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSIE JACOBY
PRESIDENT
14125 COUNTY FARM ROAD
LITTLE ROCK AR 72223

Officer/Director/Trustee Two

WES GROSS
TREASURE VICE PRESIDENT
10 PONTALBA DRIVE
LITTLE ROCK AR 72211

Officer/Director/Trustee Three

JAN CROSBY
SECRETARY
14318 WESTBURY DRIVE
LITTLE ROCK AR 72223

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/7/2016
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N32 - Parks and Playgrounds
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 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
Signature Title
Signature Date

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