FORM 1023-EZ for SUSAN HAXTON MEMORIAL FOUNDATION INC

Field Data
EIN 82-0613111
Case Number EO-2017061-000280
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SUSAN HAXTON MEMORIAL FOUNDATION INC
Organization’s Mailing Address 124 CANTERBURY TRAIL
City WEST SENECA
State NY
ZIP 14224-2544
Accounting period End 12
Primary contact name RAFAEL F PIGNATARO ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LOREN HAXTON III
PRESIDENT, DIRECTOR
124 CANTERBURY TRAIL
WEST SENECA NY 14224-2544

Officer/Director/Trustee Two

LOREN HAXTON IV
VICE PRESIDENT, DIRECTOR
312 MICHAEL ROAD
ORCHARD PARK NY 14127-1206

Officer/Director/Trustee Three

JEFFREY HAXTON
TREASURER, DIRECTOR
151 PINEWOOD DRIVE
WEST SENECA NY 14224-4919

Officer/Director/Trustee Four

SEAN HAXTON
SECRETARY, DIRECTOR
814 SWEENEY STREET
NORTH TONAWANDA NY 14120-6401

Officer/Director/Trustee Five

ROSEANN CELLINO
DIRECTOR
3951 SOWLES ROAD
HAMBURG NY 14075-2312

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
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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