FORM 1023-EZ for BUTTERFLY MOON INC

Field Data
EIN 47-4767702
Case Number EO-2015264-000399
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BUTTERFLY MOON INC
Organization’s Mailing Address 6360 REBECCA ROAD
City LOCKPORT
State NY
ZIP 14094
Accounting period End 12
Primary contact name VIVIAN JIMENEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

VIVIAN JIMENEZ
PRESIDENT
6360 LOCKPORT ROAD
LOCKPORT NY 14094

Officer/Director/Trustee Two

AMY DESANTIS
VICE PRESIDENT
6 MITCHELL DRIVE
TONAWANDA NY 14150

Officer/Director/Trustee Three

JANEEN WILDER
SECRETARY
89 SEMINOLE PARKWAY
BUFFALO NY 14210

Officer/Director/Trustee Four

LAURIE HAYES
TREASURER
2902 EGGERT ROAD
TONAWANDA NY 14150

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A70 - Humanities Organizations
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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