FORM 1023-EZ for FOR SAMANTHA INC

Field Data
EIN 82-5288683
Case Number EO-2018128-000703
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FOR SAMANTHA INC
Organization’s Mailing Address 259 IRONBARK COURT
City BOLINGBROOK
State IL
ZIP 60440
Accounting period End 12
Primary contact name MICHELLE PIERONI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE PIERONI
DIRECTOR
259 IRONBARK COURT
BOLINGBROOK IL 60440

Officer/Director/Trustee Two

PAYTON PIERONI
DIRECTOR
259 IRONBARK COURT
BOLINGBROOK IL 60440

Officer/Director/Trustee Three

MARGARET SPANO
DIRECTOR
12218 S SPRINGFIELD
ALSIP IL 60803

Officer/Director/Trustee Four

KATHLEEN DEVER
DIRECTOR
14407 LAWNDALE
MIDLOTHIAN IL 60445

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/18
Organization Incorporation State IL
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: Yes
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 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 MICHELLE PIERONI
Signature Title DIRECTOR
Signature Date 5/1/18

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