FORM 1023-EZ for SCN2A RESEARCH FOUNDATION

Field Data
EIN 47-2484744
Case Number EO-2015036-000245
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SCN2A RESEARCH FOUNDATION
Organization’s Mailing Address 5523 PAPAGALLO DRIVE
City OCEANSIDE
State CA
ZIP 92057
Accounting period End 12
Primary contact name KELLEY DALBY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KELLEY DALBY
PRESIDENT/DIRECTOR
5523 PAPAGALLO DRIVE
OCEANSIDE CA 92057

Officer/Director/Trustee Two

ALEX NEMIROFF
VICE PRES/DIRECTOR
5523 PAPAGALLO DRIVE
OCEANSIDE CA 92057

Officer/Director/Trustee Three

RANDALL DALBY
TREASURER/DIRECTOR
5523 PAPAGALLO DRIVE
OCEANSIDE CA 92057

Officer/Director/Trustee Four

DANIELLE NEMIROFF
SECRETARY/DIRECTOR
5523 PAPAGALLO DRIVE
OCEANSIDE CA 92057

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/1/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code H54 - Epilepsy Research
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 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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