FORM 1023-EZ for MEMORIAL OF JOLENE RANTAPAA

Field Data
EIN 47-4924608
Case Number EO-2016365-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEMORIAL OF JOLENE RANTAPAA
Organization’s Mailing Address 18995 GAVER ROAD
City BELLE FOURCHE
State SD
ZIP 57717
Accounting period End 12
Primary contact name DANNICA PERCEVICH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANNICA PERCEVICH
DIRECTOR
18995 GAVER RD
BELLE FOURCHE SD 57717

Officer/Director/Trustee Two

JENNA RANTAPAA
DIRECTOR
792 STATE RUN ROAD
DEADWOOD SD 57732

Officer/Director/Trustee Three

KURT RANTAPAA
DIRECTOR
21902 US HWY 385
DEADWOOD SD 57732

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/2/2015
Organization Incorporation State SD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 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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