FORM 1023-EZ for BE MODEST BOUTIQUE

Field Data
EIN 82-1095216
Case Number EO-2017160-000201
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BE MODEST BOUTIQUE
Organization’s Mailing Address 2363 GARDNER DRIVE
City FAIRBORN
State OH
ZIP 45324-8543
Accounting period End 12
Primary contact name REBECCA HICKEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REBECCA HICKEY
MAIN OFFICER
2363 GARDNER DRIVE
FAIRBORN OH 45324-8543

Officer/Director/Trustee Two

AVERY OSBORNE
OFFICER
800 NORTH MAPLES AVE
FAIRBORN OH 45324-5453

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/2017
Organization Incorporation State OH
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: 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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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