FORM 1023-EZ for BUTTERNUT VALLEY FOOD PANTRY

Field Data
EIN 47-4499142
Case Number EO-2015212-000143
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BUTTERNUT VALLEY FOOD PANTRY
Organization’s Mailing Address 219
City GILBERTSVILLE
State NY
ZIP 13776-0219
Accounting period End 12
Primary contact name WILLIAM FULLER PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM FULLER
PRESIDENT, BOARD OF DIRECTORS
124 GLENN LA
SOUTH NEW BERLIN NY 13843-3205

Officer/Director/Trustee Two

LYNN HOADLEY
TREASURER, BOARD OF DIRECTORS
PO BOX 357
GILBERTSVILLE NY 13776-0357

Officer/Director/Trustee Three

MARY HANKEY
SECRETARY, BOARD OF DIRECTORS
467 DIMMOCK HOLLOW RD
MORRIS NY 13808

Officer/Director/Trustee Four

LORI PECK
BOARD OF DIRECTORS
PO BOX 85
GILBERTSVILLE NY 13776

Organization’s website N/A
Organization’s email WLFULLER@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/2015
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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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