FORM 1023-EZ for ANTLER HISTORICAL SOCIETY INC

Field Data
EIN 85-4310402
Case Number EO-2021039-000199
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANTLER HISTORICAL SOCIETY INC
Organization’s Mailing Address 10839 HIGHWAY 256
City ANTLER
State ND
ZIP 58711
Accounting period End 12
Primary contact name MARK JORGENSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROGER ARTZ
PRESIDENT
900 MAIN STREET
ANTLER ND 58711

Officer/Director/Trustee Two

JOSEPH DONNELLY
VICE PRESIDENT
160 1ST ST
WESTHOPE ND 58711

Officer/Director/Trustee Three

MARK JORGENSEN
SECRETARY/TREASURER
10839 HIGHWAY 256
ANTLER ND 58711

Officer/Director/Trustee Four

SHARON TENNYSON
BOARD MEMBER
313 ELLA STREET
ANTLER ND 58711

Organization’s website ANTLERND.COM
Organization’s email ANTLERHISTORY@SRT.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/2020
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A80 - Historical Societies, Related Historical Activities
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 No
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 MARK JORGENSEN
Signature Title SECRETARY/TREASURER
Signature Date 12/21/2020

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