FORM 1023-EZ for THE JUSTIN HAYSTRAND MEMORIAL SCHOLARSHIP INC

Field Data
EIN 82-4693693
Case Number EO-2019035-000815
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE JUSTIN HAYSTRAND MEMORIAL SCHOLARSHIP INC
Organization’s Mailing Address 5148 WORTH COURT
City NEW PORT RICHEY
State FL
ZIP 34653
Accounting period End 12
Primary contact name DENISE HAYSTRAND
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENISE HAYSTRAND
PRESIDENT
5148 WORTH COURT
NEW PORT RICHEY FL 34653

Officer/Director/Trustee Two

AMY ALLEY
VICE PRESIDENT
7411 TANGLEWOOD DRIVE
NEW PORT RICHEY FL 34654

Officer/Director/Trustee Three

CHAD MARSH
VICE PRESIDENT
14211 S 18TH STREET
BELLEVUE NE 68123

Officer/Director/Trustee Four

CHARLEEN MARSH
DIRECTOR
14211 S 18TH STREET
BELLEVUE NE 68123

Officer/Director/Trustee Five

AMANDA HAYSTRAND
DIRECTOR
8414 SHALLOW CREEK COURT
NEW PORT RICHEY FL 34653

Organization’s website
Organization’s email JJH21FOREVER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 DENISE HAYSTRAND
Signature Title PRESIDENT
Signature Date 1/13/19

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