FORM 1023-EZ for PAY IT FORWARD CLUB INC

Field Data
EIN 81-1794374
Case Number EO-2016075-000058
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PAY IT FORWARD CLUB INC
Organization’s Mailing Address 610 RUTLAND STREET
City CARLISLE
State MA
ZIP 01741
Accounting period End 12
Primary contact name KRIS HALES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LAURA O CONNOR
PRESIDENT AND TREASURER
145 RIVERBEND DRIVE
GROTON MA 01450

Officer/Director/Trustee Two

SARA WILSON
SECRETARY
CLARK FARM ROAD
CARLISLE MA 01741

Officer/Director/Trustee Three

PAMELA ELY
EXECUTIVE DIRECTOR
610 RUTLAND STREET
CARLISLE MA 01741

Officer/Director/Trustee Four

KRIS HALES
AUTHORIZED AGENT
28 MIDDLESEX ROAD
WATERTOWN MA 02472

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2016
Organization Incorporation State MA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 Yes
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
Signature Title
Signature Date

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