FORM 1023-EZ for WAVERLY CHOW FOR CHILDREN

Field Data
EIN 82-1457256
Case Number EO-2017150-000464
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name WAVERLY CHOW FOR CHILDREN
Organization’s Mailing Address PO BOX 661
City WAVERLY
State NY
ZIP 14892
Accounting period End 12
Primary contact name ELLEN TUBBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONALD JAYNE
PRESIDENT
102 TRACY RD
WAVERLY NY 14892

Officer/Director/Trustee Two

JOSEPH DABROSKI
TREASURER
RR2
SAYRE PA 18840

Officer/Director/Trustee Three

NANCY SMITH
SECRETARY
55 WARREN ST
SAYRE PA 18840

Officer/Director/Trustee Four

COLLEEN HALL
SCHOOL REP
45 LINCOLN ST
WAVERLY NY 14892

Officer/Director/Trustee Five

DESIREE COLE
PARENT REP
637 RT17C LOT30
WAVERLY NY 14892

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/27/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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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