FORM 1023-EZ for COLLEEN CLARKE BUCKET LIST WISHES INC

Field Data
EIN 83-1998284
Case Number EO-2018325-000168
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLLEEN CLARKE BUCKET LIST WISHES INC
Organization’s Mailing Address 275 N QUEENS AVENUE
City MASSAPEQUA
State NY
ZIP 11758
Accounting period End 6
Primary contact name STEPHANIE SUAREZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY CLARKE
DIRECTOR
275 N QUEENS AVENUE
MASSAPEQUA NY 11758

Officer/Director/Trustee Two

KEVIN CLARKE
DIRECTOR
275 N QUEENS AVENUE
MASSAPEQUA NY 11758

Officer/Director/Trustee Three

KAITLYN CLARKE
DIRECTOR
275 N QUEENS AVENUE
MASSAPEQUA NY 11758

Officer/Director/Trustee Four

LAUREN CLARKE
DIRECTOR
275 N QUEENS AVENUE
MASSAPEQUA NY 11758

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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 MARY CLARKE
Signature Title DIRECTOR
Signature Date 11/19/18

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