FORM 1023-EZ for BROKEN SHACKLES

Field Data
EIN 47-5671586
Case Number EO-2016014-000364
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BROKEN SHACKLES
Organization’s Mailing Address 18960 BAKER ROAD
City BEND
State OR
ZIP 97702-7917
Accounting period End 12
Primary contact name BRENT KINKADE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

STEPHEN BASCOM
DIRECTOR/PRESIDENT
18960 BAKER ROAD
BEND OR 97702-7917

Officer/Director/Trustee Two

HENRY PORTER
DIRECTOR
18960 BAKER ROAD
BEND OR 97702-7917

Officer/Director/Trustee Three

STEVEN WELBOURN
DIRECTOR/SECRETARY/TREASURER
18960 BAKER ROAD
BEND OR 97702-7917

Organization’s website
Organization’s email STEVE.BROKENSHACKLES@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I43 - Services to Prisoners and Families - Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 Yes
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
Signature Title
Signature Date

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