FORM 1023-EZ for JACK DAPPA BLUES HERITAGE PRESERVATION FOUNDATION

Field Data
EIN 81-4594897
Case Number EO-2016347-000344
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACK DAPPA BLUES HERITAGE PRESERVATION FOUNDATION
Organization’s Mailing Address 1420 BRONX RIVER AVE SUITE 7B
City BRONX
State NY
ZIP 10472
Accounting period End 12
Primary contact name LAMONT JACK PEARLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENISE PEARLEY
DIRECTOR
1420 BRONX RIVER AVE SUITE 7B
BRONX NY 10472

Officer/Director/Trustee Two

DIERDRE SKINNER
DIRECTOR
518 WEST 148TH ST APT 1B
NEW YORK NY 10031

Officer/Director/Trustee Three

LAMONT JACK PEARLEY
CHAIRMAN
1420 BRONX RIVER AVE 7B
BRONX NY 10472

Officer/Director/Trustee Four

MARQUISE KNOX
DIRECTOR
1201 W LOCUST ST
BOWLING GREEN MO 63334

Officer/Director/Trustee Five

VALERIE TURNER
DIRECTOR
181-12 HENLEY ROAD
JAMAICA, NY 11432

Organization’s website HTTPS://WWW.FACEBOOK.COM/GROUPS/JACKDAPPABLUES/
Organization’s email LAMONTJACKPEARLEY@RACEFILMMUSIC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/7/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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