FORM 1023-EZ for THE AMELIA D TERRY SCHLARSHIP FOUNDATION INC

Field Data
EIN 52-2403018
Case Number EO-2019142-000323
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE AMELIA D TERRY SCHLARSHIP FOUNDATION INC
Organization’s Mailing Address 2 HAUSCH BLVD
City ROOSEVELT
State NY
ZIP 11575
Accounting period End 6
Primary contact name ROBERT E UMPHLETT CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM TERRY
PRESIDENT
2 HAUSCH BLVD
ROOSEVELT NY 11575

Officer/Director/Trustee Two

ZADA TERRY
SECRETARY
2 HAUSCH BLVD
ROOSEVELT NY 11575

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/4/04
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name WILLIAM TERRY
Signature Title PRESIDENT
Signature Date 5/20/19

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