FORM 1023-EZ for PET CARE ASSISTANCE FOUNDATION INC

Field Data
EIN 83-2974876
Case Number EO-2019036-000328
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PET CARE ASSISTANCE FOUNDATION INC
Organization’s Mailing Address PO BOX 127
City MIDDLEBURGH
State NY
ZIP 12122
Accounting period End 12
Primary contact name KIM CONKLIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIM CONKLIN
DIRECTOR
PO BOX 127
MIDDLEBURGH NY 12122

Officer/Director/Trustee Two

NICHOLAS CONKLIN
DIRECTOR
PO BOX 127
MIDDLEBURGH NY 12122

Officer/Director/Trustee Three

MICHELLE ROSEN-LEVY
DIRECTOR
45 WILLIAM ST
SADDLEBROOK NJ 7663

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/6/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T99 - Philanthropy, Voluntarism, and Grantmaking Foundations N.E.C.
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 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 KIM CONKLIN
Signature Title DIRECTOR
Signature Date 1/17/19

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