FORM 1023-EZ for FOUNDATION 17

Field Data
EIN 83-2370098
Case Number EO-2018305-000345
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOUNDATION 17
Organization’s Mailing Address POST OFFICE BOX 161
City PRINCE GEORGE
State VA
ZIP 23803
Accounting period End 12
Primary contact name PAUL W BURROUGHS TREASURER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRIS ABRAHAM
PRESIDENT; DIRECTOR
3300 BROOKS PARK DRIVE
PETERSBURG VA 23805

Officer/Director/Trustee Two

DONALD HANNUKSLEA
VICE PRESIDENT; DIRECTOR
POST OFFICE BOX 58
DISPUTANTA VA 23842

Officer/Director/Trustee Three

JOHN E PEARSON JR
SECRETARY; DIRECTOR
7100 WHISPERING WINDS DRIVE 62
PRINCE GEORGE VA 23875

Officer/Director/Trustee Four

PAUL W BURROUGHS
TREASURER; DIRECTOR
3875 WOODCROFT DRIVE
DISPUTANTA VA 23842

Officer/Director/Trustee Five

WILLIAM KING
DIRECTOR
14917 PROVIDENCE ROAD
S PRINCE GEORGE VA 23805

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/24/18
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I21 - Delinquency Prevention
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 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 PAUL W BURROUGHS
Signature Title TREASURER; DIRECTOR
Signature Date 10/30/18

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