FORM 1023-EZ for DALTON VAN LEGACY

Field Data
EIN 86-2717577
Case Number EO-2021116-000683
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DALTON VAN LEGACY
Organization’s Mailing Address 2784 WEST 1200 NORTH
City ROOSEVELT
State UT
ZIP 84066
Accounting period End 12
Primary contact name CONNIE VAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL VAN
PRESIDENT
2784 WEST 1200 NORTH
ROOSEVELT UT 84066

Officer/Director/Trustee Two

CONNIE VAN
VICE PRESIDENT
2784 W 1200 N
ROOSEVELT UT 84066

Officer/Director/Trustee Three

KARSON COOMBS
OFFICER
422 E 1220 S
VERNAL UT 84078

Officer/Director/Trustee Four

RICKY PRATHER
DIRECTOR
1428 E 8250 S
MYTON UT 84052

Officer/Director/Trustee Five

DEAN WILSON
DIRECTOR
340 AREVA RD
ROOSEVELT UT 84066

Organization’s website
Organization’s email CONNIE_VAN@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2021
Organization Incorporation State UT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 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 CONNIE VAN
Signature Title VICE PRESIDENT
Signature Date 4/24/2021

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