FORM 1023-EZ for CHEYENNE COUNTY CASA

Field Data
EIN 46-0901731
Case Number EO-2015348-000360
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHEYENNE COUNTY CASA
Organization’s Mailing Address PO BOX 647
City SIDNEY
State NE
ZIP 69162
Accounting period End 12
Primary contact name REBECCA NAPIER TREASURER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

HEATHER SEGELKE
PRESIDENT
PO BOX 601
SIDNEY NE 69162

Officer/Director/Trustee Two

NANCY BRADFORD
VICE PRESIDENT
1023 10TH AVENUE
SIDNEY NE 69162

Officer/Director/Trustee Three

KYLE LARSON
SECRETARY
1129 22ND AVENUE
SIDNEY NE 69162

Officer/Director/Trustee Four

REBECCA NAPIER
TREASURER
3481 ROAD 119
SIDNEY NE 69162

Organization’s website WWW.CHEYENNECOUNTYCASA.ORG
Organization’s email DIRECTOR@CHEYENNECOUNTYCASA.ORG
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2011
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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