FORM 1023-EZ for MAURICE AC KIRKWOOD JR YOUTH FOUNDATION

Field Data
EIN 81-0963905
Case Number EO-2016051-000072
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MAURICE AC KIRKWOOD JR YOUTH FOUNDATION
Organization’s Mailing Address 17350 WILTSHIRE BLVD
City SOUTHFIELD
State MI
ZIP 48076
Accounting period End 12
Primary contact name PETRINA EDMONDSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PETRINA EDMONDSON
EXECUTIVE DIRECTOR
17350 WILTSHIRE BLVD
SOUTHFIELD MI 48076

Officer/Director/Trustee Two

KANIELLE POUNDS
BOARD PRESIDENT
15251 FORRER ST
DETROIT MI 48227

Officer/Director/Trustee Three

JASMINE CARDENAS ADEOYE
BOARD TREASURER
11919 COUNTRY GARDEN DR
RANCHO CORDOVA MI 95742

Officer/Director/Trustee Four

STACEY WATSON
BOARD SECRETARY
2525 TREES OF AVALON PARKWY
MCDONOUGH GA 30253

Officer/Director/Trustee Five

JASON ANDERSON
BOARD MEMBER
5838 E 11 MILE RD
WARREN MI 48091

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2016
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 Yes
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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