FORM 1023-EZ for KOTECKI MEMORIAL FUND

Field Data
EIN 84-2655303
Case Number EO-2019247-000238
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KOTECKI MEMORIAL FUND
Organization’s Mailing Address 419 CHAPELDALE DRIVE
City APOLLO
State PA
ZIP 15613
Accounting period End 12
Primary contact name JACLYN SHAW ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHASTA BASSETT
INCORPORATOR
152 CHURCH STREET
BLAIRSVILLE PA 15717

Officer/Director/Trustee Two

AUDRA FLEMM
INCORPORATOR
2813 KNIGHTS COURT
LOWER BURRELL PA 15068

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/29/19
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
Literary: Yes
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 SHASTA BASSETT
Signature Title INCORPORATOR
Signature Date 9/2/19

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