FORM 1023-EZ for PAPILLON EMPOWERMENT

Field Data
EIN 82-1193785
Case Number EO-2017128-000019
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PAPILLON EMPOWERMENT
Organization’s Mailing Address 915 CENTRAL ST SE
City OLYMPIA
State WA
ZIP 98501
Accounting period End 12
Primary contact name SHELLEY CLAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHELLEY CLAY
CEO
915 CENTRAL ST SE
OLYMPIA WA 98501

Officer/Director/Trustee Two

CALLIE HIMSL
VICE PRESIDENT/SECRETARY
915 CENTRAL ST SE
OLYMPIA WA 98501

Officer/Director/Trustee Three

LOICK MUYUKA
CFO
915 CENTRAL ST SE
OLYMPIA WA 98501

Organization’s website PAPILLONEMPOWERMENT.ORG
Organization’s email INFO@PAPILLONEMPOWERMENT.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/14/2017
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q30 - International Development, Relief Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds No
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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