FORM 1023-EZ for PAY IT FORWARD

Field Data
EIN 82-2614144
Case Number EO-2020297-000156
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PAY IT FORWARD
Organization’s Mailing Address 4250 CENTER STREET EXT
City SALAMANCA
State NY
ZIP 14779-9792
Accounting period End 12
Primary contact name TIMOTHY JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIMOTHY JACKSON
PRESIDENT
4250 CENTER STREET EXT
SALAMANCA NY 14779-9792

Officer/Director/Trustee Two

SHIRLEY ROSZYK
VICE PRESIDENT
5471 STATE ROUTE 353
LITTLE VALLEY NY 14755

Officer/Director/Trustee Three

SANDRA BRUNDAGE
SECRETARY
36 SOUTH AVE
SALAMANCA NY 14779

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/28/2017
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 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 TIMOTHY JACKSON
Signature Title PRESIDENT
Signature Date 10/19/2020

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