FORM 1023-EZ for JACKSON AND CAMERON CLARK FOUNDATION

Field Data
EIN 87-2749410
Case Number EO-2021272-000213
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACKSON AND CAMERON CLARK FOUNDATION
Organization’s Mailing Address 11048 NORTH CLOUD VIEW PLACE
City ORO VALLEY
State AZ
ZIP 85737-7070
Accounting period End 12
Primary contact name JOSHUA CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSHUA CLARK
DIRECTOR
11048 NORTH CLOUD VIEW PLACE
ORO VALLEY AZ 85737-7070

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents No
Organization Incorporation Date 8/15/2021
Organization Incorporation State AZ
Contains Limitation No
Does not expressly empower No
Contains dissolution No
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption Yes
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
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 No
Signature Name JOSHUA CLARK
Signature Title DIRECTOR
Signature Date 9/27/2021

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