FORM 1023-EZ for BLACKAT FOUNDATION

Field Data
EIN 82-5322756
Case Number EO-2018136-000416
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACKAT FOUNDATION
Organization’s Mailing Address 4920 NE 47TH AVENUE
City PORTLAND
State OR
ZIP 97218-1652
Accounting period End 12
Primary contact name TRACI FLITCRAFT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRACI FLITCRAFT
PRESIDENT
4920 NE 47TH AVENUE
PORTLAND OR 97218-1652

Officer/Director/Trustee Two

JUSTIN HOWE
DIRECTOR
4920 NE 47TH AVENUE
PORTLAND OR 97218-1652

Officer/Director/Trustee Three

JOHN FLITCRAFT
DIRECTOR
7907 SE 106TH AVENUE
PORTLAND OR 97266-6332

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name TRACI FLITCRAFT
Signature Title PRESIDENT
Signature Date 5/14/18

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