FORM 1023-EZ for MY FIRST DENTAL VISIT INC

Field Data
EIN 81-5159766
Case Number EO-2017053-000087
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY FIRST DENTAL VISIT INC
Organization’s Mailing Address 3 MIRAGE LANE
City CLAY
State NY
ZIP 13041
Accounting period End 12
Primary contact name JULIE VARNEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JULIE VARNEY
PRESIDENT
3 MIRAGE LANE
CLAY NY 13041

Officer/Director/Trustee Two

LISA ROGERS
VICE-PRESIDENT
28 FLORAL AVENUE
CORTLAND NY 13045

Officer/Director/Trustee Three

LISA SPRADLEY
SECRETARY
39 TIMBER RIDGE
PURVIS MS 39475

Officer/Director/Trustee Four

AMY PARKER
TREASURER
107 FERGUSON AVENUE
NORTH SYRACUSE NY 13212

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/18/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E70 - Public Health Program (Includes General Health and Wellness Promotion Services)
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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