FORM 1023-EZ for THE MILES BLACKWELL FOUNDATION INC

Field Data
EIN 90-0815700
Case Number EO-2015336-000330
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name THE MILES BLACKWELL FOUNDATION INC
Organization’s Mailing Address 24757 DEER RIDGE LANE
City ATHENS
State AL
ZIP 35611
Accounting period End 12
Primary contact name ROSALYN BLACKWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DERRICK BLACKWELL
PRESIDENT OF THE BOARD
24757 DEER RIDGE LANE
ATHENS AL 35613

Officer/Director/Trustee Two

ROSALYN BLACKWELL
PRESIDENT CORPORATION
24757 DEER RIDGE LANE
ATHENS AL 35611

Organization’s website WWW.4MILESKINDNESS.COM
Organization’s email BLACKWELLROSALYN@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/2012
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - 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 Yes
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 No
One Third Support Gifts Yes
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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