FORM 1023-EZ for JERSEY VILLAGE SENIOR OUTREACH CORP

Field Data
EIN 81-3196360
Case Number EO-2016328-000139
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JERSEY VILLAGE SENIOR OUTREACH CORP
Organization’s Mailing Address 16308 SMITH STREET
City JERSEY VILLAGE
State TX
ZIP 77040-2164
Accounting period End 12
Primary contact name GEORGE HAUBENREICH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JO HEWETT
PRESIDENT AND DIRECTOR
16308 SMITH STREET
JERSEY VILLAGE TX 77040-2164

Officer/Director/Trustee Two

STAN POLAK
TREASURER AND DIRECTOR
16308 SMITH STREET
JERSEY VILLAGE TX 77040-2164

Officer/Director/Trustee Three

KARIE LAWRENCE
DIRECTOR
16308 SMITH STREET
JERSEY VILLAGE TX 77040-2164

Officer/Director/Trustee Four

NANCY FRANKEL
SECRETARY
16308 SMITH STREET
JERSEY VILLAGE TX 77040-2164

Officer/Director/Trustee Five

GEORGE HAUBENREICH
ASSISTANT SECRETARY
16308 SMITH STREET
JERSEY VILLAGE TX 77040-2164

Organization’s website WWW.JVSO.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/13/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 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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