FORM 1023-EZ for BARBARA MEMORIAL INC

Field Data
EIN 36-4822789
Case Number EO-2015350-000157
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BARBARA MEMORIAL INC
Organization’s Mailing Address 155 NE NAZARENE CHURCH WAY
City MADISON
State FL
ZIP 32340
Accounting period End 12
Primary contact name JANICE AGNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SAMUEL AGNER
PRESIDENT
235 NE NAZARENE CHURCH WAY
MADISON FL 32340

Officer/Director/Trustee Two

DONALD AGNER
VICE PRESIDENT
167 NE CHICORY TRL
MADISON FL 32340

Officer/Director/Trustee Three

JANICE AGNER
TREASURER
235 NE NAZARENE CHURCH WAY
MADISON FL 32340

Organization’s website SUNBIZ.ORG
Organization’s email JANAGNER@CENTURYLINK.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/21/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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
Signature Title
Signature Date

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