FORM 1023-EZ for JEFFERSON PARK ASSOCIATION INC

Field Data
EIN 45-3849301
Case Number EO-2015114-000280
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON PARK ASSOCIATION INC
Organization’s Mailing Address 733 N CLAY
City JACKSONVILLE
State IL
ZIP 62651
Accounting period End 12
Primary contact name TILDE HOLMES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SAMUEL HOLMES SR
PRESIDENT
PO BOX 1264
JACKSONVILLE IL 62651

Officer/Director/Trustee Two

SAMUEL STUART
VICE PRESIDENT
1318 W LAFAYETTE
JACKSONVILLE IL 62650

Officer/Director/Trustee Three

NONA NEFF
SECRETARY
8 AARON DR
JACKSONVILLE IL 62650

Officer/Director/Trustee Four

TILDE HOLMES
TREASURER
PO BOX 1264
JACKSONVILLE IL 62651

Officer/Director/Trustee Five

NICK XAMIS
DIRECTOR
1312 W MORTON
JACKSONVILLE IL 62650

Organization’s website
Organization’s email TILDEHOLMES@MSN.OCM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/2011
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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