FORM 1023-EZ for JACOBSEN MIDDLE SCHOOL PARENT TEACHER ORGANIZATION

Field Data
EIN 82-4993474
Case Number EO-2018094-000103
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JACOBSEN MIDDLE SCHOOL PARENT TEACHER ORGANIZATION
Organization’s Mailing Address 711 ANITA DR
City TEHACHAPI
State CA
ZIP 93561
Accounting period End 12
Primary contact name DONALD NAPIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHEA EHRESMAN
PRESIDENT, DIRECTOR
711 ANITA DR
TEHACHAPI CA 93561

Officer/Director/Trustee Two

JULIE KINGSBURY
SECRETARY, DIRECTOR
711 ANITA DR
TEHACHAPI CA 93561

Officer/Director/Trustee Three

MONICA LAMONTE
TREASURER, DIRECTOR
711 ANITA DR
TEHACHAPI CA 93561

Officer/Director/Trustee Four

STEVIE MARTINEZ
DIRECTOR
711 ANITA DR
TEHACHAPI CA 93561

Officer/Director/Trustee Five

DONALD NAPIER
DIRECTOR
711 ANITA DR
TEHACHAPI CA 93561

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/13/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 SHEA EHRESMAN
Signature Title PRESIDENT, DIRECTOR
Signature Date 4/2/18

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