FORM 1023-EZ for COUNT US IN INC

Field Data
EIN 85-0941154
Case Number EO-2020160-000556
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COUNT US IN INC
Organization’s Mailing Address 2843 E STATE BLVD
City FORT WAYNE
State IN
ZIP 46805
Accounting period End 6
Primary contact name JALYN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JALYN RADZIMINSKI
DIRECTOR
2815 HAZELWOOD AVE
FORT WAYNE IN 46805-2401

Officer/Director/Trustee Two

MYRON TROWELL
OFFICER
5306 MACY LANE
FORT WAYNE IN 46818

Organization’s website
Organization’s email COUNTUSINDIANA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/16/2020
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R40 - Voter Education, Registration
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
Correctness Declaration Yes
Signature Name JALYN RADZIMINSKI
Signature Title DIRECTOR
Signature Date 6/6/2020

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