FORM 1023-EZ for ROSA JACKSON COMMUNITY CENTER ADVISORY BOARD

Field Data
EIN 84-2022949
Case Number EO-2019193-000116
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROSA JACKSON COMMUNITY CENTER ADVISORY BOARD
Organization’s Mailing Address 1211 MAYNARD STREET
City MACON
State GA
ZIP 31217
Accounting period End 12
Primary contact name ARIZONA WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOMINIQUE JOHNSON
PRESIDENT
228 LAUREL LANE
LIZELLA GA 31052

Officer/Director/Trustee Two

NEIDRA JONES
TREASURER
639 SHORT ST E
MACON GA 31217

Officer/Director/Trustee Three

QUANDRA SWAIN
SECRETARY
3568 CONFEDERATE DRIVE
MACON GA 31211

Officer/Director/Trustee Four

SHEKNITA DAVIS
VICE PRESIDENT
3000 SIDNEY COURT
MACON GA 31217

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/19
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N11 - Single Organization Support
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 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 DOMINIQUE JOHNSON
Signature Title PRESIDENT
Signature Date 7/10/19

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