FORM 1023-EZ for JERSEYDOM FOUNDATION A NJ NONPROFITCORPORATION

Field Data
EIN 47-4291820
Case Number EO-2015294-000122
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JERSEYDOM FOUNDATION A NJ NONPROFITCORPORATION
Organization’s Mailing Address 57 WALLINGTON AVEUNE
City WALLINGTON
State NJ
ZIP 07057
Accounting period End 12
Primary contact name CHARLOTTE DELLAQUILA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JASON DELLAQUILA
TRUSTEE AND VICE PRESIDENT
57 WALLINGTON AVENUE
WALLINGTON NJ 07057

Officer/Director/Trustee Two

CHARLOTTE DELLAQUILA
TRUSTEE AND SECRETARY
106 TERRACE AVENUE
ROCHELLE PARK NJ 07662

Officer/Director/Trustee Three

GINA CIRILLO
TRUSTEE AND TREASURER
460 TULANE COURT
PARAMUS NJ 07652

Officer/Director/Trustee Four

LUCILO SANTOS
TRUSTEE
18 WILLOW AVENUE
HACKENSACK NJ 07601

Officer/Director/Trustee Five

KENIA DELLAQUILA
PRESIDENT
57 WALLINGTON AVENUE
WALLINGTON NJ 07057

Organization’s website JERSEYDOM.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/17/2015
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q33 - International Relief
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 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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