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ZIEDUAL
Fo,m C HAR410
Registration Statement for Charitable Organizations
New York State Department of Law (Office of the Attorney General)
46-81-05
Charities Bureau - Registration Section .
.-
120 Broadway
New York, NY 10271
www.charitiesnys.corn/

Part A - Identification of Registrant

1. Full name of organization (exactly as it appears in your organizing document) 5. Fed. employer ID no. (EIN)

Pacific Park Conservancy, Inc. 8 2 -2 7 239 56

2. do Name (if applicable) 6 Organization's website

Atlantic Yards Venture, LLC N/A

3. Mailing address (Number and street) Room/suite 7 Primary contact

1 Metrotech Center, 18th Floor Ashley Cotton

City or town, state or country and ZIP+4 Title

Brooklyn, NY 11201 Chairperson and President

4. Principal NYS address (Number and street) Room/suite Phone Fax

1 Metrotech Center, 18th Floor (718) 559-5115 N/A

City or town, state or country and ZIP+4 Email

Brooklyn, NY 11201 acotton@Ilmag.com

Part B - Certification - Two Signatures Required

We certify under penalties for perjury that we reviewed this ' tration Statement, including all schedules and attachments, and to the best of our
knowledge and belief, they are true, correct and compl e 1 c or c with the laws of the State of New York applicable to this statement.

Ashle Cotton Chair erson and President 8/10/18

1. President or Authorized Officer/Trustee
Sig t _~~:,~-:8,lated Name Title Date

ifford Schwartz Treasurer 8/10/18

2. Chief Financial Officer or Treasurer
Signatu Printed Name Title Date

Part C - Fee Submitted

If registering to solicit contributions, fee is $25. Check <> IW if you are submitting $25 fee to Submit check or money order,
If not registering to solicit contributions, no fee is owed. register to solicit contributions . payable to "NYS Department of Law."

Part D - Attachments - All Documents Required

Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration:
• Certificate of incorporation, trust agreement or other organizing document, and any amendments; and See Exhibit A, Attachment 2
Bylaws or other organizational rules, and any amendments; and See Exhibit A, Attachment 3
· IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and See Exhibit A
IRS tax exemption determination letter (if applicable) To be provided upon receipt from IRS

Part E - Request for Registration Exemption

Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? . . 0 Yes* E) No
* if "Yes", complete Schedule E.

Page 1 of 3 Form CHAR410 (2010)

Part F - Organization Structure
1. Incorporation / formation
a. Type of organization: b. Type of corporation if New York not-for-profit corporation
Corporation......... B El c El D El
Limited liability company (LLC) . El
Partnership ..... ......... El c. Date incorporated if a corporation or formed if other than a corporation
Sole proprietorship .......
Trust m 07/11/20 1 7
Unincorporated association.... El d. State in which incorporated or formed

* If Other, describe:
New York

2. List all chapters, branches and affiliates of your organization (attach additional sheets if necessary)
Mailing address (number and street, room/suite,
Name Relationship City or town, state or country and zip+4)

N/A

3. List all officers, directors, trustees and key employees

Mailing address (number and street, room/suite, End of term
Name Title city or town, state or country and zip+4) (if applicable)

1 1
See Exhibit B

1 1

1 1

1 1

1 1

1 1

1 1

1 1

4. Other Names and Registration Numbers

a. List all other names used by your organization, including any prior names
N/A
b. List all prior New York State charities registration numbers for the organization, including those from the New York State Attorney General's
Charities Bureau or the New York State Department of State's Office of Charities Registration
N/A

Page 2 of 3 Form CHAR410 (2010)

Part G - Organization Activities
1. Month the annual accounting period ends (01-12) 2. NTEE code

12 N32
3. Date organization began doing each of following in New York State:
a. conducting activity............. .
b. maintaining assets. ··311/11/-2018
c. soliciting contributions (including from residents, foundations, corporations, government agencies, etc.) . . . . . . . . . _N/A-/__/_-
4. Describe the purposes of your organization
The purpose of the organization is to own, plan, program, operate, maintain, secure, and improve for
public recreational and other charitable purposes the publicly accessible open space located in the
Borough of Brooklyn, City and State of New York, to be known as Pacific Park, being developed as part of the
Atlantic Yards Land Use Improvement and Civic Project.

5. Has your organization or any of your officers, directors, trustees or key employees been:
a. enjoined or otherwise prohibited by a government agency or court from soliciting contributions? . . 0 Yes* 13 No
* If "Yes", describe:

b. found to have engaged in unlawful practices in connection with the solicitation or administration of charitable assets? . . 0 Yes* ~ No
* if "Yes", describe:

6. Has your organization's registration or license been suspended by any government agency? 0 Yes* 1 No
* if "Yes", describe:

7. Does your organization solicit or intend to solicit contributions (including from residents, foundations, corporations, government
agencies, etc.) in New York State? ......... ... Il Yes* ZA No
* If "Yes", describe the purposes for which contributions are or will be solicited:
The organization does not currently solicit or have plans to solicit contributions in New York State. However, in the future,
it may decide to solicit contributions to be used solely in furtherance of its charitable purposes related to the operation
and maintenance of Pacific Park, for the benefit of the public.

8. List all fund raising professionals (FRP) that your organization has engaged for fund raising activity in NY State (attach additional sheets if
necessary)
Type of FRP Mailing address (number and street, room/suite,
Name (see instructions for definitions) city or town, state or country and zip+4) Dates of contract

0 Start date:
PFR
N/A FRC 0
End date:
CCV
Start date:
PFR 0
FRC 0 End date:
CCV
Start date:
PFR
FRC End date:
CCV 0

Part H - Federal Tax Exempt Status

1. If applicable, list the date your organization:
a. applied for tax exempt status........ .08/03_/2-018
b. was granted tax exempt status .M/8-/__/____
c. was denied tax exempt status _NIA/__/____
d. had its tax exempt status revoked
2. Provide Internal Revenue Code provision: 501(c)(3)

Page 3 of 3 Form CHAR410 (2010)

 EXHIBIT B
BOARD OE DIRECTORS
 End of Term
(and until such
Director's
successor has
been
Name Title Address appointed and
qualified)
Brooklyn Community Board 8
1291 St. Marks Avenue
Glinda Andrews
Director Brooklyn, NY 11213 12/15/18
Empire State Development
Corporation
633 Third Avenue
Alyson Beha
Director New York, NY 10017 12/15/18
1 Metrotech Center, 18th Floor
John Bowen
Director Brooklyn, NY 11201 12/15/18
1 Metrotech Center, 18th Floor
Christina Chao
Director Brooklyn, NY 11201 12/15/18
L & L MAG
Director, Chairperson, 594 Dean Street
Ashley Cotton
and President Brooklyn, NY 11238 12/15/18
1 Metrotech Center, 18th Floor
Jen Kuang Director Brooklyn, NY 11201 12/15/18
NYU Tandon School of
Engineering
15 Metro Tech Center, 6th Floor
Sayar Lonial Director Brooklyn, NY 11201 12/15/18
New York City Department of
Parks and Recreation
The Arsenal
Central Park
Ma rtin M a her Director (non-voting) New York, NY 10065 12/15/18
Brooklyn Bridge Park
Corporation
334 Furman Street
Suma Mandel Director Brooklyn, NY 11201 12/15/18
550 Vanderbilt Avenue, Unit
1009
Josie Mok Director Brooklyn, NY 11238 12/15/18
1 Metrotech Center, 18th Floor
Stephanie Rosenberg Director and Secretary Brooklyn, NY 11201 12/15/18
1 Metrotech Center, 18th Floor
Clifford Schwartz Director and Treasurer Brooklyn, NY 1-1201 12/15/18
1 Metrotech Center, 18th Floor
Scott Solish Director Brooklyn, NY 11201 12/15/18
 COPY OF WITHIN PAPER
RECEIVED

SEP 0 4 2018
RNEY GENS'F~\t,
NYS OFFICE OF THE ATTO
CHARITIES BUREAU