FORM 1023-EZ for COUSIN COLLECTIVE INC

Field Data
EIN 84-2074627
Case Number EO-2019203-000238
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COUSIN COLLECTIVE INC
Organization’s Mailing Address 3568 ELMWOOD DR
City RIVERSIDE
State CA
ZIP 92506
Accounting period End 12
Primary contact name ADAM PIRON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADAM PIRON
PRESIDENT
3568
RIVERSIDE FL 92506

Officer/Director/Trustee Two

ALEXANDRA LAZAROWICH
TREASURER
203 MAUJER ST APT 3R
BROOKLYN NY 11206

Officer/Director/Trustee Three

SKY HOPINKA
SECRETARY
830 E CHAMBERS ST
MILWAUKEE WI 53212

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A99 - Arts, Culture, and Humanities N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ADAM PIRON
Signature Title PRESIDENT
Signature Date 7/18/19

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