FORM 1023-EZ for MEADOWBROOK DOG PARK ASSOCIATION

Field Data
EIN 82-3106444
Case Number EO-2017304-000065
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEADOWBROOK DOG PARK ASSOCIATION
Organization’s Mailing Address PO BOX 6268
City NORFOLK
State VA
ZIP 23508-0268
Accounting period End 12
Primary contact name JOHN DOMENA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHN DOMENA
PRESIDENT
1503 RUNNYMEDE RD
NORFOLK VA 23505-2903

Officer/Director/Trustee Two

LARRY BURGE
VICE PRESIDENT
1417 TROUVILLE AVE
NORFOLK VA 23505

Officer/Director/Trustee Three

DAVID CHASE
SECRETARY
1515 TROUVILLE AVE
NORFOLK VA 23505

Officer/Director/Trustee Four

STEVE CYRUS
TREASURER
1420 RUNNYMEDE RD
NORFOLK VA 23505

Organization’s website
Organization’s email MEADOWBROOKDOGPARK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/28/2017
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N32 - Parks and Playgrounds
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 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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