FORM 1023-EZ for DAVID BLITZ MEMORIAL FUND

Field Data
EIN 82-0875716
Case Number EO-2017094-000283
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DAVID BLITZ MEMORIAL FUND
Organization’s Mailing Address PO BOX 284
City FEEDING HILLS
State MA
ZIP 01030
Accounting period End 12
Primary contact name JENNIFER AUGUSTI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER AUGUSTI
PRESIDENT
1143 SHOEMAKER LANE
FEEDING HILLS MA 01030

Officer/Director/Trustee Two

LITA BLITZ
VICE PRESIDENT
51 FLAT ROCK RD
BRANFORD CT 06405

Officer/Director/Trustee Three

CARL JOSEPHSON
TREASURER
16 MARIE LANE
WALLINGFORD CT 06492

Officer/Director/Trustee Four

LAURA JOSEPHSON
SECRETARY
16 MARIE LANE
WALLINGFORD CT 06492

Organization’s website
Organization’s email DAVEBLITZGOLFTOURNAMENT@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2017
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P12 - Fund Raising and/or Fund Distribution
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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