FORM 1023-EZ for NORTH KINGSTOWN ANIMAL SHELTER SUPPORT FOUNDATION

Field Data
EIN 47-1339101
Case Number EO-2015009-000261
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NORTH KINGSTOWN ANIMAL SHELTER SUPPORT FOUNDATION
Organization’s Mailing Address 23 IRON HORSE TERRACE
City NORTH KINGSTOWN
State RI
ZIP 02852
Accounting period End 7
Primary contact name SUSAN SIEKIERA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SUSAN SIEKIERA
PRESIDENT
23 IRON HORSE TERRACE
NORTH KINGSTOWN RI 02852

Officer/Director/Trustee Two

LISA DEWETTER
TREASURER
43 NICHOLS ROAD
NORTH KINGSTOWN RI 02852

Officer/Director/Trustee Three

DAVID BERGMANN
DIRECTOR
170 WEST MAIN ST
NORTH KINGSTOWN RI 02852

Officer/Director/Trustee Four

MARIA CARDI
DIRECTOR
24 DUCK COVE FARM
NORTH KINGSTOWN RI 02852

Officer/Director/Trustee Five

STEPHEN BRIGGS JR
DIRECTOR
3700 QUAKER LANE
NORTH KINGSTOWN RI 02852

Organization’s website NKASSF.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/16/2014
Organization Incorporation State RI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D11 - Single Organization Support
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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