FORM 1023-EZ for CHIVE ON NORTH DAKOTA INC

Field Data
EIN 81-1065408
Case Number EO-2016194-000120
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHIVE ON NORTH DAKOTA INC
Organization’s Mailing Address 11160 41ST ST SW
City DICKINSON
State ND
ZIP 58601
Accounting period End 12
Primary contact name JENAYA KITI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENAYA KITI
PRESIDENT
11160 41ST SW
DICKINSON ND 58601

Officer/Director/Trustee Two

KAYLA FENDER
VICE PRESIDENT
1149 LAKOTA LANE
LINCOLN ND 58504

Officer/Director/Trustee Three

EMILY MURPHY
SECRETARY
2741 PRAIRIE OAK DR
DICKINSON ND 58601

Officer/Director/Trustee Four

CRYSTAL STRAND
TREASURER
613 2ND AVE E NUMBER 2
WEST FARGO ND 58078

Officer/Director/Trustee Five

ALEX MACHADO
MERCHANDISER
110 2 GRAMERCY CT
MINOT AFB ND 58704

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/2015
Organization Incorporation State ND
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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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