FORM 1023-EZ for JAKOBS HOME FOR HOMELESS

Field Data
EIN 84-4617169
Case Number EO-2021172-000031
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JAKOBS HOME FOR HOMELESS
Organization’s Mailing Address 10074 CODY DRISKELL ROAD LOT 2
City GRAND BAY
State AL
ZIP 36541
Accounting period End 12
Primary contact name DOMINIQUE NELSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOMINIQUE NELSON
PRESIDENT
10074 CODY DRISKELL ROAD LOT 2
GRAND BAY AL 36541

Officer/Director/Trustee Two

FRED NELSON JR
DIRECTOR
10074 CODY DRISKELL ROAD LOT 2
GRAND BAY AL 36541

Officer/Director/Trustee Three

AMBER FILA
DIRECTOR
10074 CODY DRISKELL ROAD LOT 2
GRAND BAY AL 36541

Officer/Director/Trustee Four

KAMKA GOINGS
DIRECTOR
10074 CODY DRISKELL ROAD LOT 2
GRAND BAT AL 36541

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/10/2020
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 DOMINIQUE NELSON
Signature Title PRESIDENT
Signature Date 6/16/2021

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