FORM 1023-EZ for S J ADULT AND ADOLESCENT SERVICES

Field Data
EIN 81-4841182
Case Number EO-2017046-000097
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name S J ADULT AND ADOLESCENT SERVICES
Organization’s Mailing Address 380 ANCESTRY LANE
City DALLAS
State TX
ZIP 75217
Accounting period End 12
Primary contact name SHAKURIA UPRETI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAKURIA UPRETI
DIRECTOR
380 ANCESTRY LANE
DALLAS TX 75217

Officer/Director/Trustee Two

JACKIE THOMPSON
TREASURER
1020 SCOTLAND
DESOTO TX 75115

Officer/Director/Trustee Three

JACQUELINE BONNER
SECRETARY
212 STANFORD DR
FORNEY TX 75126

Organization’s website SJADULTAND.ORG
Organization’s email SJADOLESCENTS.ORG@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/7/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
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
Signature Title
Signature Date

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