FORM 1023-EZ for BLESSED FOUNDATION

Field Data
EIN 47-5669174
Case Number EO-2016021-000469
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLESSED FOUNDATION
Organization’s Mailing Address 39808 25TH STREET WEST
City PALMDALE
State CA
ZIP 93551
Accounting period End 12
Primary contact name LAWRENCE D LARRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LAWRENCE D LARRY
PRESIDENT / CEO
39808 25TH STREET WEST
PALMDALE CA 93551

Officer/Director/Trustee Two

JULIE M LARRY
TREASURER / PROGRAM DIRECTOR
39808 25TH STREET WEST
PALMDALE CA 93551

Officer/Director/Trustee Three

STACIA DOSTER
SECRETARY
3230 RYANS PL
LANCASTER CA 93536

Officer/Director/Trustee Four

STEPHEN LAYNE
BOARD MEMBER
37716 PELLION COURT
PALMDALE CA 93550

Officer/Director/Trustee Five

RYAN JEFFERSON
BOARD MEMBER
3902 LENAWEE AVE APT 24
CULVER CITY CA 90232

Organization’s website N/A
Organization’s email LAWRENCEDLARRY@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/9/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 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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