FORM 1023-EZ for RA KIRBY FOUNDATION

Field Data
EIN 47-2060512
Case Number EO-2015072-000627
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RA KIRBY FOUNDATION
Organization’s Mailing Address 508 S HARRISON STREET
City PHILO
State IL
ZIP 61864-9501
Accounting period End 12
Primary contact name LESLIE KIRBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LESLIE KIRBY
PRESIDENT CO-FOUNDER
508 S HARRISON STREET
PHILO IL 61864-9501

Officer/Director/Trustee Two

LUCAS KIRBY
VICE PRESIDENT CO-FOUNDER
508 S HARRISON STREET
PHILO IL 61964-9501

Officer/Director/Trustee Three

DANIELLE KREUSER
SECRETARY
3804 BROOKFIELD DRIVE
CHAMPAIGN IL 61822

Organization’s website
Organization’s email LESLIEKIRB@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/18/2014
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G12 - Fund Raising and/or Fund Distribution
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 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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