FORM 1023-EZ for DARIUS S SHACKLEFORD FOUNDATION

Field Data
EIN 86-1976525
Case Number EO-2021090-000757
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DARIUS S SHACKLEFORD FOUNDATION
Organization’s Mailing Address P O BOX 825
City NEWARK
State OH
ZIP 43058
Accounting period End 12
Primary contact name MARY THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY THOMAS
SECRETARY/ADVISOR DIRECTOR
PO BOX 825
NEWARK OH 43058

Officer/Director/Trustee Two

DWAN VICKROY
CHIEF FINANCIAL DIRECTOR
2075 WEST RUSHVILLE RD
LANCASTER OH 43130

Officer/Director/Trustee Three

DANIEL SHACKLEFORD JR
FOUNDATION DIRECTOR
85 BUILDERS DR SUITE 32
NEWARK OH 43055

Officer/Director/Trustee Four

DEVONTA SHACKLEFORD
SCHOLORSHIP DIRECTOR
896 KING RD APT B
NEWARK OH 43055

Officer/Director/Trustee Five

DANIEL SHACKLEFORD SR
ADVOCACY DIRECTOR
298 MONTGOMERY AVE
NEWARK OH 43055

Organization’s website
Organization’s email DariusSShacklefordFoundation@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/9/2021
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development 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 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 MARY THOMAS
Signature Title SECRETARY/ADVISOR DIRECTOR
Signature Date 2/17/2021

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