FORM 1023-EZ for CHAY YA USA

Field Data
EIN 81-3447626
Case Number EO-2016218-000171
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHAY YA USA
Organization’s Mailing Address 606 S 13TH AVE
City BOZEMAN
State MT
ZIP 59715
Accounting period End 12
Primary contact name WILLIAM KELLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIAM KELLER
PRESIDENT
606 S 13TH AVE
BOZEMAN MT 59715

Officer/Director/Trustee Two

GERRY PARIS
SECRETARY
3230 ARENA BLVD 245-291
SACRAMENTO CA 95834

Officer/Director/Trustee Three

JILL BAUMLER
TREASURER
20269 NORRIS BLVD
MANHATTEN MT 59741

Organization’s website
Organization’s email GERRYPARIS3@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/16/2015
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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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