FORM 1023-EZ for NATIVE ROOTS FARM INC

Field Data
EIN 46-0761986
Case Number EO-2014310-000172
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATIVE ROOTS FARM INC
Organization’s Mailing Address 942 NORTH 651 EAST
City WESTVILLE
State IN
ZIP 46391
Accounting period End 12
Primary contact name DAMIEN J APPEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAMIEN APPEL
PRESIDENT
942 NORTH 651 EAST
WESTVILLE IN 46391

Officer/Director/Trustee Two

DAVID APPEL
DIRECTOR
942 NORTH 651 EAST
WESTVILLE IN 46391

Officer/Director/Trustee Three

DANA HAND
DIRECTOR
410 EAST 900 NORTH
VALPARAISO IN 46383

Organization’s website WWW.NATIVEROOTSFARM.ORG
Organization’s email NATIVEROOTSFARM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/8/2012
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K20 - Agricultural Programs
Organization’s purpose Charitable: Yes
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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