FORM 1023-EZ for REBECCA JEAN KLEMEN MEMORIAL FOUNDATION INC

Field Data
EIN 81-0886981
Case Number EO-2015358-000068
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REBECCA JEAN KLEMEN MEMORIAL FOUNDATION INC
Organization’s Mailing Address 524 KAREN DR
City PITTSBORO
State IN
ZIP 46167
Accounting period End 12
Primary contact name EDWARD KLEMEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EDWARD KLEMEN
PRESIDENT
524 KAREN DR
PITTSBORO IN 46167

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2015
Organization Incorporation State IN
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 Yes
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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