FORM 1023-EZ for BLACK ROCK FARM INC

Field Data
EIN 83-1528202
Case Number EO-2019190-000122
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK ROCK FARM INC
Organization’s Mailing Address 2018 S 1ST ST
City MILWAUKEE
State WI
ZIP 53207-1102
Accounting period End 12
Primary contact name VICTOR WEXLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEWEY DE GRAVE
PRESIDENT
W4703 POTTER RD
ELKHORN WI 53121

Officer/Director/Trustee Two

REBECCA DE GRAVE
SECRETARY
W4703 POTTER RD
ELKHORN WI 53121

Officer/Director/Trustee Three

VICTOR WEXLER
REG AGENT & DIRECTOR
2018 S 1ST ST
MILWAUKEE WI 53207-1102

Officer/Director/Trustee Four

MORRENE WEXLER
TREASURER
2018 S 1ST ST
MILWAUKEE WI 53207-1102

Officer/Director/Trustee Five

DANIELLE JANSEN
DIRECTOR
W4715 POTTER RD
ELKHORN WI 53121

Organization’s website
Organization’s email TAXINFO@VWEXLERCPA.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/10/18
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
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 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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name VICTOR WEXLER
Signature Title REG AGENT & DIRECTOR
Signature Date 7/3/19

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