FORM 1023-EZ for JACKIES FUND

Field Data
EIN 84-5058174
Case Number EO-2020072-000142
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACKIES FUND
Organization’s Mailing Address HC 69 BOX 299
City RANDLETT
State UT
ZIP 84063
Accounting period End 12
Primary contact name ADRI ANN WOOTTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADRI ANN WOOTTON
FOUNDER
HC 69 BOX 299
RANDLETT UT 84063

Officer/Director/Trustee Two

KORGRETTA GINES
OFFICER
230 WEST LAGOON STREET
ROOSEVELT UT 84066

Officer/Director/Trustee Three

JESSICA WOOTTON
OFFICER
8686 CASTLE COVE ROAD
VERNAL UT 84078

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/2/2020
Organization Incorporation State UT
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: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 ADRI ANN WOOTTON
Signature Title FOUNDER
Signature Date 3/10/2020

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