FORM 1023-EZ for PROJECT BLACKOUT

Field Data
EIN 82-2030085
Case Number EO-2017205-000269
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PROJECT BLACKOUT
Organization’s Mailing Address 64 LONDON BRIDGE ROAD
City WINDHAM
State NH
ZIP 03087
Accounting period End 6
Primary contact name JOAN POTTER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM RAYCRAFT
DIRECTOR PRESIDENT
64 LONDON BRIDGE ROAD
WINDHAM NH 03087

Officer/Director/Trustee Two

JOAN POTTER
DIRECTOR SECRETARY
6 CHESTNUT STREET
WINDHAM NH 03087

Officer/Director/Trustee Three

SHEILA ARINELLO
DIRECTOR
19 BUCKHIDE ROAD
WINDHAM NH 03087

Officer/Director/Trustee Four

SHANNON BOUDREAU
DIRECTOR TREASURER
22 ROLLING RIDGE ROAD
WINDHAM NH 03087

Officer/Director/Trustee Five

JENNIFER SCHRAMM
DIRECTOR
20 SHEFFIELD
WINDHAM NH 03087

Organization’s website
Organization’s email PROJECTBLACKOUTNH@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/29/2017
Organization Incorporation State NH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G30 - Cancer
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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