FORM 1023-EZ for PACK YOUR BACK

Field Data
EIN 81-2402039
Case Number EO-2016141-000309
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PACK YOUR BACK
Organization’s Mailing Address 1100 S PINNEBOG RD
City BAD AXE
State MI
ZIP 48413-9747
Accounting period End 12
Primary contact name GALEN MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GALEN MILLER
PRESIDENT
1100 S PINNEBOG RD
BAD AXE MI 48413-9747

Officer/Director/Trustee Two

SAVANNAH FRASER
VICE PRESIDENT
33314 CHERYL ST
CLINTON TOWNSHIP MI 48035-3925

Officer/Director/Trustee Three

SCOTT STEWART
TREASURER
703 SEVILLE BLVD
PONTIAC MI 48340-1063

Officer/Director/Trustee Four

KAITLYN REED
SECRETARY
1629 OAK PARK DR
MUSKEGON MI 49442-5334

Organization’s website WWW.PACKYOURBACK.ORG
Organization’s email INFO@PACKYOURBACK.ORG
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2016
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P58 - Gift 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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