FORM 1023-EZ for LIVING PROOF EXHIBIT

Field Data
EIN 27-3500764
Case Number EO-2015181-000028
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVING PROOF EXHIBIT
Organization’s Mailing Address 2814 - 47TH STREET
City MOLINE
State IL
ZIP 61265
Accounting period End 12
Primary contact name PAMELA CROUCH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAMELA CROUCH
EXECUTIVE DIRECTOR
2814 47TH STREET
MOLINE IL 61265

Officer/Director/Trustee Two

MARY ELLEN CUNNINGHAM
PRESIDENT, DIRECTOR
2814 47TH STREET
MOLINE IL 61265

Officer/Director/Trustee Three

CHRIS ZAYMER
DIRECTOR
2814 47TH STREET
MOLINE IL 61265

Officer/Director/Trustee Four

JACKI OLSON
DIRECTOR
2814 47TH STREET
MOLINE IL 61265

Officer/Director/Trustee Five

EMILY CHRISTENSEN
DIRECTOR
2814 47TH STREET
MOLINE IL 61265

Organization’s website WWW.LIVINGPROOFEXHIBIT.COM
Organization’s email LIVINGPROOFEXHIBIT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/2010
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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