FORM 1023-EZ for BLOOMINGTAILS DOG PARK INC

Field Data
EIN 47-5344148
Case Number EO-2015357-000179
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLOOMINGTAILS DOG PARK INC
Organization’s Mailing Address 88 BLOOMINGDALE ROAD
City STATEN ISLAND
State NY
ZIP 10309
Accounting period End 12
Primary contact name JEANINE HANSSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

VINCENT STEFFEN
PRESIDENT/DIRECTOR
88 BLOOMINGDALE ROAD
STATEN ISLAND NY 10309

Officer/Director/Trustee Two

JEANINE HANSSON
TREASURER/DIRECTOR
88 BLOOMINGDALE ROAD
STATEN ISLAND NY 10309

Officer/Director/Trustee Three

JESSICA RAINER
SECRETARY/DIRECTOR
88 BLOOMINGDALE ROAD
STATEN ISLAND NY 10309

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/10/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D99 - Animal-Related N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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