FORM 1023-EZ for LEXIES LEGACY FOUNDATION INC

Field Data
EIN 84-2427556
Case Number EO-2019206-000067
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEXIES LEGACY FOUNDATION INC
Organization’s Mailing Address 1510 SOUTHRIDGE DR
City JANESVILLE
State WI
ZIP 53546-5835
Accounting period End 12
Primary contact name MICHAEL C DAVIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIA UNSETH
DIRECTOR
1510 SOUTHRIDGE DR
JANESVILLE WI 53546-5835

Officer/Director/Trustee Two

AMANDA GRIMES
DIRECTOR
2340 QUAIL RIDGE DR
JANESVILLE WI 53546-3146

Officer/Director/Trustee Three

KRISTI STORTZ
DIRECTOR
3719 GOLDENROD PL
JANESVILLE WI 53546-1191

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/6/19
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
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 TIA UNSETH
Signature Title DIRECTOR
Signature Date 7/23/19

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