FORM 1023-EZ for JACOB CHARITIES

Field Data
EIN 84-3108486
Case Number EO-2019266-000374
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACOB CHARITIES
Organization’s Mailing Address 8220 ONEILL DR
City MILLINGTON
State TN
ZIP 38053
Accounting period End 12
Primary contact name JOHN PEW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY MOSS
PRESIDENT
8220 ONEILL DR
MILLINGTON TN 38053

Officer/Director/Trustee Two

KENNETH JOHNSON
SECRETARY
8220 ONEILL DR
MILLINGTON TN 38053

Officer/Director/Trustee Three

DENNIS MOY
TREASURER
8220 ONEILL DR
MILLINGTON TN 38053

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/19/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y40 - Fraternal Beneficiary Societies
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 TERRY MOSS
Signature Title PRESIDENT
Signature Date 9/19/19

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