FORM 1023-EZ for WORN

Field Data
EIN 83-2301568
Case Number EO-2018298-000305
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WORN
Organization’s Mailing Address 2876 OLD YELLOW SPRINGS RD
City FAIRBORN
State OH
ZIP 45324
Accounting period End 1
Primary contact name DAVID SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID SMITH
DIRECTOR
2876 OLD YELLOW SPRINGS RD
FAIRBORN OH 45324

Officer/Director/Trustee Two

SHIRLEY THORNBURG
DIRECTOR
1508 N BARRON ST
EATON OH 45320

Officer/Director/Trustee Three

CHRISTINA KNIGHT
DIRECTOR
420 EVERGREEN
EATON OH 45320

Organization’s website
Organization’s email WORN2018@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - 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 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 Yes
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 DAVID SMITH
Signature Title DIRECTOR
Signature Date 10/23/18

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