FORM 1023-EZ for EMILY ROSE FOUNDATION INC

Field Data
EIN 47-1798902
Case Number EO-2015049-000081
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMILY ROSE FOUNDATION INC
Organization’s Mailing Address 13310 STAGE ROAD
City AKRON
State NY
ZIP 14001
Accounting period End 12
Primary contact name D JEFFREY BUCKLEY ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANNETTE ADAMCZAK
PRESIDENT/DIRECTOR
13310 STAGE ROAD
AKRON NY 14001

Officer/Director/Trustee Two

DWAYNE ADAMCZAK
TREASURER/DIRECTOR
13310 STAGE ROAD
AKRON NY 14001

Officer/Director/Trustee Three

DAVID ADAMCZAK
VICE PRESIDENT/DIRECTOR
13310 STAGE ROAD
AKRON NY 14001

Officer/Director/Trustee Four

SONIA JONATHAN
SECRETARY/DIRECTOR
30 JOHN STREET
AKRON NY 14001

Officer/Director/Trustee Five

JESSIE ADAMCZAK
DIRECTOR
522 ALLEGHANY ROAD
DARIEN NY 14040

Organization’s website N/A
Organization’s email EMILYROSE5K@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/8/2014
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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 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
Signature Title
Signature Date

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