FORM 1023-EZ for KAILEE E SMITH MEMORIAL FOUNDATION

Field Data
EIN 81-3400185
Case Number EO-2017073-000095
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KAILEE E SMITH MEMORIAL FOUNDATION
Organization’s Mailing Address 5850 W TIFFIN ST PO BOX 133
City BASCOM
State OH
ZIP 44809
Accounting period End 6
Primary contact name AMANDA MERRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

VAN MERRY
TREASURER
5850 W TIFFIN ST
BASCOM OH 44809

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/23/2016
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 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 No
One Third Support Gifts Yes
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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