FORM 1023-EZ for GRAYLA FOUNDATION INC

Field Data
EIN 84-4242794
Case Number EO-2020013-000406
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GRAYLA FOUNDATION INC
Organization’s Mailing Address 421 W HICKORY AVE
City LINTON
State ND
ZIP 58552
Accounting period End 12
Primary contact name KELSIE F BURZA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELSIE F BURZA
PRESIDENT
421 W HICKORY AVE
LINTON ND 58552

Officer/Director/Trustee Two

COREY A BURZA
VICE PRESIDENT
421 W HICKORY AVE
LINTON ND 58552

Officer/Director/Trustee Three

JEROME F GROSSMAN
DIRECTOR
515 3RD ST NE
LINTON ND 58552

Organization’s website
Organization’s email GRAYLAFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/9/2020
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T30 - Public Foundations
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 Yes
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 KELSIE F BURZA
Signature Title PRESIDENT
Signature Date 1/10/2020

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