FORM 1023-EZ for AUTOSOMAL DOMINANT OPTIC ATROPHY ASSOCIATION

Field Data
EIN 47-3897789
Case Number EO-2015189-000161
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AUTOSOMAL DOMINANT OPTIC ATROPHY ASSOCIATION
Organization’s Mailing Address 94 BETHEL COURT
City PORT MATILDA
State PA
ZIP 16870
Accounting period End 6
Primary contact name LINDSEY ALLEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LINDSEY ALLEN
BOARD OF DIRECTOR, PRESIDENT, TREAS
94 BETHEL COURT
PORT MATILDA PA 16870

Officer/Director/Trustee Two

MELISSA WERTZ
BOD, CHAIRPERSON, SECRETARY
1839 FIRST STREET NW UNIT 2
WASHINGTON DC 20001

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/19/2015
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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
Signature Title
Signature Date

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