FORM 1023-EZ for FILTHY 5K INC

Field Data
EIN 47-4576562
Case Number EO-2016053-000343
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FILTHY 5K INC
Organization’s Mailing Address 20 WEST THIRD STREET
City MAYSVILLE
State KY
ZIP 41056
Accounting period End 12
Primary contact name ANDREW DUKE FORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANDREW DUKE FORD
PRESIDENT
20 WEST THIRD STREET
MAYSVILLE KY 41056

Officer/Director/Trustee Two

MELISSA MASON
VICE PRESIDENT
20 WEST THIRD STREET
MAYSVILLE KY 41056

Officer/Director/Trustee Three

HEATHER BRETZ
SECRETARY/TREASURER
20 WEST THIRD STREET
MAYSVILLE KY 41056

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/30/2015
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N12 - 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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