FORM 1023-EZ for KIDZ KLUB INNOVATIONS INCORPORATED

Field Data
EIN 84-3381893
Case Number EO-2019305-000177
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KIDZ KLUB INNOVATIONS INCORPORATED
Organization’s Mailing Address 172 NORTH ALLEN STREET
City ALBANY
State NY
ZIP 12206
Accounting period End 12
Primary contact name ANQUINETTE HAYLES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID PENA
FOUNDER
172 NORTH ALLEN STREET
ALBANY NY 12206

Officer/Director/Trustee Two

TRITICIA PENA
BOARD MEMBER
P O BOX 627
RENSSELAER NY 12144

Officer/Director/Trustee Three

CHERYL PENA
BOARD MEMBER
1438 SUNSET ROAD
CASTLETON NY 12033

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/26/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
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 DAVID PENA
Signature Title FOUNDER
Signature Date 10/30/19

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