FORM 1023-EZ for MODOC HARVEST

Field Data
EIN 81-3226304
Case Number EO-2016214-000468
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MODOC HARVEST
Organization’s Mailing Address PO BOX 549
City CEDARVILLE
State CA
ZIP 96104-0549
Accounting period End 12
Primary contact name LAURIE WAYNE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GLORIA MARCHANT
CHAIRMAN
PO BOX 549
CEDARVILLE CA 96104-0549

Officer/Director/Trustee Two

KAY ANTUNEZ
VICE CHAIMAN
PO BOX 549
CEDARVILLE CA 96104-0549

Officer/Director/Trustee Three

TANYA SCHULZ
TREASURER
PO BOX 549
CEDARVILLE CA 96104-0549

Officer/Director/Trustee Four

REBEKKA SIEMENS
SECRETARY
PO BOX 549
CEDARVILLE CA 96104-0549

Officer/Director/Trustee Five

PAULA SM
DIRECTOR
PO BOX 549
CEDRVILLE CA 96104-0549

Organization’s website MODOCHARVEST.ORG
Organization’s email MODOCHARVEST@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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