FORM 1023-EZ for DAVID SAMSON MEMORIAL FUND

Field Data
EIN 82-6987478
Case Number EO-2019123-000148
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DAVID SAMSON MEMORIAL FUND
Organization’s Mailing Address 2 GELSEY LANE
City BASKING RIDGE
State NJ
ZIP 7920
Accounting period End 5
Primary contact name ALAN MCCLINTOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALAN MCCLINTOCK
DIRECTOR
2 GELSEY LANE
BASKING RIDGE NJ 7920

Officer/Director/Trustee Two

ANDREW PEARCE
DIRECTOR
563 WOODLAND AVENUE
MOUNTAINSIDE NJ 7092

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/24/19
Organization Incorporation State NJ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N6A - Golf
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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 ALAN MCCLINTOCK
Signature Title DIRECTOR
Signature Date 5/1/19

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