FORM 1023-EZ for ALICE PETINGE MEMORIAL FUND INC

Field Data
EIN 81-4500003
Case Number EO-2016333-000174
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ALICE PETINGE MEMORIAL FUND INC
Organization’s Mailing Address 11 DOGWOOD LANE
City MEDWAY
State MA
ZIP 02053-2177
Accounting period End 12
Primary contact name STEPHEN KUTENPLON ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL PETINGE
PRESIDENT/DIRECTOR
11 DOGWOOD LANE
MEDWAY MA 02053-2177

Officer/Director/Trustee Two

LORRAINE PETINGE
TREASURER/DIRECTOR
11 DOGWOOD LANE
MEDWAY MA 02053-2177

Officer/Director/Trustee Three

ANN DAS
CLERK/DIRECTOR
11 DOGWOOD LANE
MEDWAY MA 02053-2177

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/22/2016
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T20 - Private Grantmaking Foundations
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 No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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