FORM 1023-EZ for KILLA WASI FOUNDATION

Field Data
EIN 47-3100907
Case Number EO-2015063-000093
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KILLA WASI FOUNDATION
Organization’s Mailing Address 111 MAPLEWOOD DRIVE
City LAFAYETTE
State LA
ZIP 70503
Accounting period End 12
Primary contact name REBECCA CLICK-REX
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MELANIE ROBIN
PRESIDENT
704 LEXINGTON PARKWAY
CARENCRO LA 70520

Officer/Director/Trustee Two

REBECCA CLICK-REX
TREASURER/OFFICER
111 MAPLEWOOD DRIVE
LAFAYETTE LA 70503

Officer/Director/Trustee Three

ANN HOLLIER
BOARD CHAIR/OFFICER
305 RAYWOOD DR
LAFAYETTE LA 70503

Officer/Director/Trustee Four

LISA ZEIBELL
SECRETARY
1709 WEST WESTVIEW ST
SPRINGFIELD MO 65807

Officer/Director/Trustee Five

DEBBIE DAVIES
OFFICER
RR2 BOX 2430H
BIRCH TREE MO 65438

Organization’s website WWW.KILLAWASIFOUNDATION.ORG
Organization’s email INFO@KILLAWASIFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/6/2012
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W20 - Government and Public Administration
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 Yes
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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