FORM 1023-EZ for SGT KIP A JACOBY MEMORIAL INC

Field Data
EIN 47-5649216
Case Number EO-2015365-000167
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SGT KIP A JACOBY MEMORIAL INC
Organization’s Mailing Address 2051 NE 28TH AVE
City POMPANO BEACH
State FL
ZIP 33062
Accounting period End 9
Primary contact name SCOTT COOK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SCOTT COOK
BOARD OF DIRECTORS
2051 NE 28TH AVENUE
POMPANO BEACH FL 33062

Officer/Director/Trustee Two

RICK THONI
BOARD OF DIRECTORS
801 SE 10TH AVENUE
DEERFIELD BEACH FL 33441

Officer/Director/Trustee Three

ANNE OGREN
BOARD OF DIRECTORS
1270 NW 41ST STREET
OAKLAND PARK FL 33309

Officer/Director/Trustee Four

GRETA COOK
BOARD OF DIRECTORS
2051 NE 28TH AVENUE
POMPANO BEACH FL 33062

Officer/Director/Trustee Five

CYNTHIA KITTS
BOARD OF DIRECTORS
PO BOX 661
POMPANO BEACH FL 33061

Organization’s website
Organization’s email KIPKOOKOUT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2015
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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
Signature Title
Signature Date

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