FORM 1023-EZ for COLUMBIA PARK GREENVILLE MEMORIAL INC

Field Data
EIN 46-5666217
Case Number EO-2015104-000090
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COLUMBIA PARK GREENVILLE MEMORIAL INC
Organization’s Mailing Address 282 NEPTUNE AVENUE
City JERSEY CITY
State NJ
ZIP 07305
Accounting period End 12
Primary contact name AMANDA KHAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AMANDA KHAN
PRESIDENT
282 NEPTUNE AVENUE
JERSEY CITY NJ 07305

Officer/Director/Trustee Two

CECELIA JUSKIEWICZ
VICE PRESIDENT
197 WINFIELD AVENUE
JERSEY CITY NJ 07305

Officer/Director/Trustee Three

NOEL GARRIGA
TRUSTEE
271 GATES AVENUE
JERSEY CITY NJ 07305

Officer/Director/Trustee Four

GLORIELA DUBNER
TRUSTEE
4 SYCAMORE ROAD
JERSEY CITY NJ 07305

Officer/Director/Trustee Five

BARBARA CAMACHO
TRUSTEE
208 GARFIELD AVENUE
JERSEY CITY NJ 07305

Organization’s website
Organization’s email COLUMBIAPARKNA@USA.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/2014
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C50 - Environmental Beautification and Aesthetics
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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