FORM 1023-EZ for SPECIMEN MUSEUM

Field Data
EIN 83-1272791
Case Number EO-2019028-000294
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SPECIMEN MUSEUM
Organization’s Mailing Address 2414 N MONTICELLO AVE
City CHICAGO
State IL
ZIP 60647
Accounting period End 12
Primary contact name MICKEY ALICE KWAPIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICKEY ALICE KWAPIS
DIRECTOR
APARTMENT 1
CHICAGO IL 60647

Officer/Director/Trustee Two

JENNIFER PAVLAT
DIRECTOR
1101 5TH AVE E
ALEXANDRIA MN 56308

Officer/Director/Trustee Three

GERALD PAVLAT
DIRECTOR
1424 ENGLEWOOD AVE
ROYAL OAK MI 48073-2878

Organization’s website
Organization’s email HELLO@MICKEYALICEKWAPIS.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/13/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A56 - Natural History, Natural Science Museums
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: Yes
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 MICKEY ALICE KWAPIS
Signature Title DIRECTOR
Signature Date 12/14/18

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