FORM 1023-EZ for FILL YOUR BUCKET LIST FOUNDATION

Field Data
EIN 47-1925872
Case Number EO-2014279-000280
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FILL YOUR BUCKET LIST FOUNDATION
Organization’s Mailing Address 304 SOUTHGLEN DRIVE
City CARY
State NC
ZIP 27518
Accounting period End 12
Primary contact name JACQUELINE STANLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PEGGY CARROLL
PRESIDENT
304 SOUTHGLEN DRIVE
CARY NC 27518

Officer/Director/Trustee Two

MEGAN CARROLL
DIRECTOR OF COMMUNICATIONS
304 SOUTHGLEN DRIVE
CARY NC 27518

Officer/Director/Trustee Three

MIKE YOUNG
TREASURER
5725 THISTLETON LANE
RALEIGH NC 27606

Officer/Director/Trustee Four

PATRICIA RIVERA
VICE PRESIDENT
628 OAK CREST DRIVE
CHAPEL HILL NC 27516

Officer/Director/Trustee Five

CHRISTINA DELVECCHIO
SECRETARY
33 DONOVAN ROAD
PENNINGTON NC 08534

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/2014
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 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
Signature Title
Signature Date

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