FORM 1023-EZ for JEFFERSON STREET PARK INC

Field Data
EIN 82-4701831
Case Number EO-2018074-000154
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JEFFERSON STREET PARK INC
Organization’s Mailing Address 3162 SR 135 NORTH
City NASHVILLE
State IN
ZIP 47448-8428
Accounting period End 12
Primary contact name WANDA JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WANDA JONES
OFFICER
3162 STATE ROAD 135 NORTH
NASHVILLE IN 47448-8428

Officer/Director/Trustee Two

STEPHEN MILLER
OFFICER
104 JEFFERSON STREET NORTH
NASHVILLE IN 47448-7018

Officer/Director/Trustee Three

SUE ANN WERLING
OFFICER
7042 JUSTINS RIDGE ROAD
NASHVILLE IN 47448-9369

Officer/Director/Trustee Four

GEOFF KELLER
OFFICER
1073 HILL TOP TRAIL
NASHVILLE IN 47448-7402

Officer/Director/Trustee Five

JAY CHARON
OFFICER
3162 STATE ROAD 135 NORTH
NASHVILLE IN 47448-8428

Organization’s website
Organization’s email WEJ@INDIANAJONESLAW.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/23/17
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C30 - Natural Resources Conservation and Protection
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 WANDA JONES
Signature Title OFFICER
Signature Date 3/13/18

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