FORM 1023-EZ for COMMUNITY SERVICE NORTH DAKOTA--WILLISTON REGION

Field Data
EIN 45-0426750
Case Number EO-2014227-000153
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COMMUNITY SERVICE NORTH DAKOTA--WILLISTON REGION
Organization’s Mailing Address P O BOX 2074
City WILLISTON
State ND
ZIP 58802
Accounting period End 12
Primary contact name FLOYD GREEN JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TAYLOR OLSON
PRESIDENT, DIRECTOR
P O BOX 2074
WILLISTON ND 58802

Officer/Director/Trustee Two

JEFF NEHRING
SECRETARY, DIRECTOR
716 2ND ST W
WILLISTON ND 58801

Officer/Director/Trustee Three

JORDAN EVERT
TREASURER, DIRECTOR
P O BOX 417
WILLISTON ND 58801

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/28/2013
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: No
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 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 No
One Third Support Gifts Yes
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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