FORM 1023-EZ for JOMO AND CHARMAINE COUSINS FOUNDATION

Field Data
EIN 81-2917018
Case Number EO-2016203-000133
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JOMO AND CHARMAINE COUSINS FOUNDATION
Organization’s Mailing Address 11705 BOYETTE ROAD SUITE 525
City RIVERVIEW
State FL
ZIP 33569
Accounting period End 12
Primary contact name JOMO COUSINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOMO COUSINS
TRUSTEE
407 HAWK TALON DRIVE
LITHIA FL 33547

Officer/Director/Trustee Two

CHARMAINE COUSINS
TRUSTEE
407 HAWK TALON DRIVE
LITHIA FL 33547

Organization’s website
Organization’s email JOMOCOUSINS@GMAIL.COM
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 6/13/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T20 - Private Grantmaking Foundations
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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