FORM 1023-EZ for ANDREW D TRIPLETT MEMORIAL SCHOLARSHIP FOUNDATION INC

Field Data
EIN 81-4986871
Case Number EO-2017019-000355
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANDREW D TRIPLETT MEMORIAL SCHOLARSHIP FOUNDATION INC
Organization’s Mailing Address 2905 CAMERON MILLS RD
City ALEXANDRIA
State VA
ZIP 22302
Accounting period End 12
Primary contact name JODI SLEEPER-TRIPLETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JODI SLEEPER-TRIPLETT
DIRECTOR
2905 CAMERON MILLS RD
ALEXANDRIA VA 22302

Officer/Director/Trustee Two

PAUL TRIPLETT
DIRECTOR
2905 CAMERON MILLS RD
ALEXANDRIA VA 22302

Officer/Director/Trustee Three

ROY HAYES JR
DIRECTOR
6301 EDSALL RD 222
ALEXANDRIA VA 22312

Officer/Director/Trustee Four

AMY CHAPIN
DIRECTOR
16 BLUE SPRUCE FARM RD APT 38
WESTBROOK ME 04092

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/13/2017
Organization Incorporation State VA
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 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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