FORM 1023-EZ for JACOBS PLAYGROUND

Field Data
EIN 47-4582009
Case Number EO-2015251-000134
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACOBS PLAYGROUND
Organization’s Mailing Address 6301 COUNTY RD 10
City ROCKFORD
State MN
ZIP 55373
Accounting period End 12
Primary contact name GRANT BIRZNIEKS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GRANT BIRZNIEKS
CHAIR
6301 COUNTY RD 10
ROCKFORD MN 55373

Officer/Director/Trustee Two

KARA BIRZNIEKS
VICE CHAIR
6301 COUNTY RD 10
ROCKFORD MN 55373

Officer/Director/Trustee Three

BRANT SCHMITZ
SECRETARY
6301 COUNTY RD 10
ROCKFORD MN 55373

Officer/Director/Trustee Four

GRETCHEN REHM
TREASURER
6301 COUNTY RD 10
ROCKFORD MN 55373

Organization’s website
Organization’s email GBIRZNIEKS@HOTMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/13/2015
Organization Incorporation State MN
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 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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