FORM 1023-EZ for RACHEL LYNN HENLEY FOUNDATION

Field Data
EIN 47-4580217
Case Number EO-2015226-000318
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RACHEL LYNN HENLEY FOUNDATION
Organization’s Mailing Address 3323 N 18TH
City TACOMA
State WA
ZIP 98406-6003
Accounting period End 12
Primary contact name ANDREW L BUZZARD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARY HENLEY
DIRECTOR
3323 NORTH 18TH
TACOMA WA 98406-6003

Officer/Director/Trustee Two

ANDREW BUZZARD
DIRECTOR
7418 STANICH AVE
GIG HARBOR WA 98335

Officer/Director/Trustee Three

KELLY LAURICELLA
DIRECTOR
12306 NYANZA RD SW
LAKEWOOD WA 98499-1446

Organization’s website HTTP://WWW.RACHELLYNNHENLEYFOUNDATION.ORG
Organization’s email INFO@RACHELLYNNHENLEYFOUNDATION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/10/2015
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E12 - Fund Raising and/or Fund Distribution
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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