FORM 1023-EZ for COLLABORATIVE COMMUNITY INITIATIVEINC

Field Data
EIN 82-2561095
Case Number EO-2018277-000240
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLLABORATIVE COMMUNITY INITIATIVEINC
Organization’s Mailing Address 4035 WASHINGTON AVE
City NEW ORLEANS
State LA
ZIP 70125
Accounting period End 12
Primary contact name JESSICA JENKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA JENKINS
PRESIDENT
4020 ODIN STREET
NEW ORLEANS LA 70126

Officer/Director/Trustee Two

MICHELLE NIXON STANTON
TREASURE
3028 CLEVELAND AVE
NEW ORLEANS LA 70119-6335

Officer/Director/Trustee Three

SHANA HARTMANN
SECRETARY
912 N WHITE
NEW ORLEANS LA 70119

Organization’s website
Organization’s email CCINOLA1@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/17
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
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 MICHELLE NIXON STANTON
Signature Title TREASURE
Signature Date 10/2/18
EIN 82-2561095
Case Number EO-2018277-000240
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COLLABORATIVE COMMUNITY INITIATIVE INC
Organization’s Mailing Address 4035 WASHINGTON AVE
City NEW ORLEANS
State LA
ZIP 70125
Accounting period End 12
Primary contact name JESSICA JENKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSICA JENKINS
PRESIDENT
4020 ODIN STREET
NEW ORLEANS LA 70126

Officer/Director/Trustee Two

MICHELLE NIXON STANTON
TREASURE
3028 CLEVELAND AVE
NEW ORLEANS LA 70119-6335

Officer/Director/Trustee Three

SHANA HARTMANN
SECRETARY
912 N WHITE
NEW ORLEANS LA 70119

Organization’s website
Organization’s email CCINOLA1@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/24/17
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
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 MICHELLE NIXON STANTON
Signature Title TREASURE
Signature Date 10/2/18

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