FORM 1023-EZ for ROE JAN FOOD PANTRY INC

Field Data
EIN 83-2782300
Case Number EO-2019144-000213
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ROE JAN FOOD PANTRY INC
Organization’s Mailing Address 2648 ROUTE 23 PO BOX 475
City HILLSDALE
State NY
ZIP 12529-475
Accounting period End 12
Primary contact name HILARIE L THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BETTY WHITE
PRESIDENT
365 BREEZY HILL ROAD
HILLSDALE NY 12529

Officer/Director/Trustee Two

VERNETTA MOORE
VICE PRESIDENT
1881 ROUTE 23
CRARYVILLE NY 12521

Officer/Director/Trustee Three

LINDA MILLER
SECRETARY TREASURER
452 NORTH MOUNTAIN ROAD
COPAKE FALLS NY 12517

Officer/Director/Trustee Four

JANE DWY
DIRECTOR
1075 COUNTY ROUTE 7
ANCRAM NY 12502

Organization’s website NA
Organization’s email ROEJANFOODPANTRY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/10/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 BETTY WHITE
Signature Title PRESIDENT
Signature Date 5/22/19

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