FORM 1023-EZ for BLUE SANTA OF UPSHUR COUNTY INC

Field Data
EIN 86-1881102
Case Number EO-2021089-000335
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE SANTA OF UPSHUR COUNTY INC
Organization’s Mailing Address 109 W TYLER ST
City GILMER
State TX
ZIP 75644
Accounting period End 12
Primary contact name CYNTHIA CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CYNTHIA CLARK
OFFICER
125 OLD HWY 271 N
GILMER TX 75644

Officer/Director/Trustee Two

LATICA JENKINS
TREASURER
202 N LEXINGTON RD
GILMER TX 75755

Officer/Director/Trustee Three

JOYCE MOON
DIRECTOR
374 CATCLAW RD
BIG SANDY TX 75755

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/2/2021
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
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 CYNTHIA CLARK
Signature Title OFFICER
Signature Date 2/10/2021

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