FORM 1023-EZ for CLARKSBURG SCHOOL FOUNDATION

Field Data
EIN 46-0838144
Case Number EO-2015299-000382
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLARKSBURG SCHOOL FOUNDATION
Organization’s Mailing Address 1869 E 600 NORTH RD
City SHELBYVILLE
State IL
ZIP 62565-4147
Accounting period End 12
Primary contact name DALE WINES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DALE WINES
PRESIDENT
1869 E 600 NORTH RD
SHELBYVILLE IL 62565-4147

Officer/Director/Trustee Two

LES EDWARDS
VICE PRESIDENT
1905 E 750 NORTH RD
SHELBYVILLE IL 62565-4126

Officer/Director/Trustee Three

SHARON DEVORE
TREASURER
2213 E 600 NORTH RD
MODE IL 62444-4074

Officer/Director/Trustee Four

PHYLLIS ALLEN
SECRETARY
2230 E 500 NORTH RD
MODE IL 62444-4074

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/7/2012
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 Yes
One Third Support Gifts No
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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