FORM 1023-EZ for JEREMY A COLLINS MEMORIAL FOUNDATION

Field Data
EIN 46-1076050
Case Number EO-2015219-000325
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEREMY A COLLINS MEMORIAL FOUNDATION
Organization’s Mailing Address PO BOX 117
City LEAVITTSBURG
State OH
ZIP 44430
Accounting period End 12
Primary contact name JENNIFER STOCKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PATRICIA WILMOTH
PRESIDENT
1542 DENISON AVE NW
WARREN OH 44485

Officer/Director/Trustee Two

TINA HAGANS
VP
34 RIDGE RD APT 82
NEWTON FALLS OH 44444

Officer/Director/Trustee Three

JESSICA KOHLER
SEC /TREASURER
8105 S PARK BLVD
GARRETTSVILLE OH 44231

Organization’s website WWW.JCMF.BBNOW.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/16/2014
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
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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