FORM 1023-EZ for MISSION TOOTHBRUSH INC

Field Data
EIN 81-2282513
Case Number EO-2016147-000231
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MISSION TOOTHBRUSH INC
Organization’s Mailing Address 36 CAROLINE AVENUE
City SETAUKET
State NY
ZIP 11733
Accounting period End 12
Primary contact name HUGH FERGUSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GREGORY FERGUSON
TRUSTEE
36 CAROLINE AVE
SETAUKET NY 11733

Officer/Director/Trustee Two

HUGH FERGUSON
TRUSTEE, DIRECTOR
36 CAROLINE AVE
SETAUKET NY 11733

Officer/Director/Trustee Three

JOSH FARAHZAD
TRUSTEE, DIRECTOR
17 LAUREL DRIVE
STONY BROOK NY 11790

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G19 - Nonmonetary Support N.E.C.
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 Yes
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 Yes
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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