FORM 1023-EZ for AMY BUTLER FOUNDATION

Field Data
EIN 81-1673800
Case Number EO-2016155-000198
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AMY BUTLER FOUNDATION
Organization’s Mailing Address 9628 SLOWAY COAST DRIVE
City LORTON
State VA
ZIP 22079
Accounting period End 12
Primary contact name AYESHIA QUAINOO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AYESHIA QUAINOO
PRESIDENT
9628 SLOWAY COAST DR
LORTON VA 22079

Officer/Director/Trustee Two

ADELAIDE ETSE
TREASURE
8654 FOUNTAIN VALLEY DR
GAITHERSBURG MD 20886

Officer/Director/Trustee Three

SHERIKA JACKSON
SECRETARY
3019 SEMINOLE RD
WOODBRIDGE VA 22192

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/3/2016
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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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