FORM 1023-EZ for PAY IT FORWARD COFFEE INC

Field Data
EIN 83-4027839
Case Number EO-2019094-000369
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PAY IT FORWARD COFFEE INC
Organization’s Mailing Address 304 RIVER OAKS DRIVE
City BAKERFIELD
State CA
ZIP 93309
Accounting period End 12
Primary contact name MICHAEL OSTHIMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL OSTHIMER
PRESIDENT
304 RIVER OAKS DRIVE
BAKERSFIELD CA 93309

Officer/Director/Trustee Two

BRETT OSTHIMER
TREASURER
9401 FOXGLEN
BAKERSFIELD CA 93312

Officer/Director/Trustee Three

JASON TRUITT
VICE PRESIDENT
5000 SEA STAR LANE
BAKERSFIELD CA 93309

Officer/Director/Trustee Four

LEE OSTHIMER
SECRETARY
304 RIVER OAKS DRIVE
BAKERSFIELD CA 93309

Officer/Director/Trustee Five

MICHAEL ATKISON
CHAIRPERSON
2020 BRADFORD STREET
BAKERSFIELD CA 93304

Organization’s website PAYITFORWARDCOFFEE.ORG
Organization’s email REMITSO@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/5/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X12 - 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 Yes
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 MICHAEL OSTHIMER
Signature Title PRESIDENT
Signature Date 4/2/19

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