FORM 1023-EZ for PACK-A-SNACK PROGRAM

Field Data
EIN 46-1915407
Case Number EO-2016028-000173
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PACK-A-SNACK PROGRAM
Organization’s Mailing Address 732 MAIN ST
City RAINELLE
State WV
ZIP 25962
Accounting period End 12
Primary contact name CHRISTINE CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTINE CLARK
PRESIDENT
6801 BACKUS RD
MEADOW BRIDGE WV 25976

Officer/Director/Trustee Two

SANDRA SORRELLS
VICE-PRESIDENT
234 13TH ST
RAINELLE WV 25962

Officer/Director/Trustee Three

MICKEY CLARK
TREASURER
6801 BACKUS RD
MEADOW BRIDGE WV 25976

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/1/2013
Organization Incorporation State WV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 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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