FORM 1023-EZ for LAKE ANNA JAZZ

Field Data
EIN 87-1844051
Case Number EO-2021210-000441
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE ANNA JAZZ
Organization’s Mailing Address P O BOX 61
City MINERAL
State VA
ZIP 23117-0061
Accounting period End 12
Primary contact name ROBERT KERR MCBRIDE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT MCBRIDE
PRESIDENT-SECRETARY
251 MAPLE MULL
MINERAL VA 23117

Officer/Director/Trustee Two

VIRGINIA GOLDBERG
VICE-PRESIDENT
12333 FIELD LARK COURT
FAIRFAX VA 22033

Officer/Director/Trustee Three

LAURA CINQUINI
TREASURER
1536 JATO COURT
WOODBRIDGE VA 22192

Organization’s website WWW.LAKEANNAJAZZ.ORG
Organization’s email INFO@LAKEANNAJAZZ.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/19/2021
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A68 - Music
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 ROBERT MCBRIDE
Signature Title PRESIDENT-SECRETARY
Signature Date 7/27/2021

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