FORM 1023-EZ for ELEVATE FOUR CORNERS INC

Field Data
EIN 47-3385638
Case Number EO-2015079-000158
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ELEVATE FOUR CORNERS INC
Organization’s Mailing Address 139 LAKE NANUET DR
City NANUET
State NY
ZIP 10954
Accounting period End 3
Primary contact name RACHEL WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRIAN JENSEN
PRESIDENT
121 S HILLSIDE AVENUE
NESCONSET NY 11767

Officer/Director/Trustee Two

RACHEL P WILLIAMS
SECRETARY AND TREASURER
139 LAKE NANUET DRIVE
NANUET NY 10954

Officer/Director/Trustee Three

JUSTIN SLEMP
BOARD MEMBER
PO BOX 1186
SCAPPOOSE OR 97056

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/3/2013
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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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