FORM 1023-EZ for A PAY IT FORWARD FOUNDATION

Field Data
EIN 82-2763273
Case Number EO-2018186-000338
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A PAY IT FORWARD FOUNDATION
Organization’s Mailing Address PO BOX 14635
City MADISON
State WI
ZIP 53708
Accounting period End 12
Primary contact name MICHAEL JAHN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL JAHN
DIRECTOR
PO BOX 14635
MADISON WI 53708

Officer/Director/Trustee Two

CHERYL PETRYCZKOWYCZ
FUNDRAISING/ENTERTAINMENT DIRECTOR
1415 PENNIMAN AVE
PLYMOUTH MI 48170

Officer/Director/Trustee Three

ALLEN KOCH
MARKETING
215 S CENTURY AVE 118
WAUNAKEE WI 53597

Officer/Director/Trustee Four

SANDRA KISTING
TREASURER
7510 ROLICH CT APT 7
MIDDLETON WI 53562

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/17
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code J19 - Nonmonetary Support N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: Yes
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 MICHAEL JAHN
Signature Title DIRECTOR
Signature Date 7/2/18

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