FORM 1023-EZ for OUT OF THE BLUE WNY INC

Field Data
EIN 81-1983472
Case Number EO-2016125-000137
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OUT OF THE BLUE WNY INC
Organization’s Mailing Address 21 MILFORD STREET
City HAMBURG
State NY
ZIP 14075-4713
Accounting period End 12
Primary contact name DAVID SIMONI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOUGLAS SMITH
PRESIDENT
21 MILFORD STREET
HAMBURG NY 14075-4713

Officer/Director/Trustee Two

DEBORAH DIVITA-CLEARY
TREASURER
4736 CLIFTON PARKWAY
HAMBURG NY 14075-3202

Officer/Director/Trustee Three

DAVID SIMONI
SECRETARY
239 LINDEN AVENUE
BUFFALO NY 14216-2811

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/15/2016
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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
Signature Title
Signature Date

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