FORM 1023-EZ for BREVARD PARKINSONS SUPPORT GROUP INC

Field Data
EIN 81-2556430
Case Number EO-2016152-000320
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BREVARD PARKINSONS SUPPORT GROUP INC
Organization’s Mailing Address 45 MARINA ISLES BLVD
City INDIAN HARBOUR BEACH
State FL
ZIP 32937
Accounting period End 6
Primary contact name MARIEKE KREPS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARIEKE KREPS
PRESIDENT
45 MARINA ISLES BLVD
INDIAN HARBOUR BEACH

Officer/Director/Trustee Two

STACEY CLARK
VICE PRESIDENT
281 PEAKE STREET NE
PALM BAY FL 32907

Officer/Director/Trustee Three

JAQUELINE ESTERLINE
SECRETARY
1881 LAMEQUE STREET
PALM BAY FL 32907

Officer/Director/Trustee Four

CHRIS WHITE
TREASURER
2819 MARIAH DRIVE
MELBOURNE FL 32940

Officer/Director/Trustee Five

EMERY JONES
MEMBER
220 WATERSIDE DRIVE
INDIAN HARBOUR BEACH

Organization’s website
Organization’s email S_M_KREPS@MSN.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - 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 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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