FORM 1023-EZ for CLINTON SCOTT MUSGRAVE MEMORIAL FUND

Field Data
EIN 47-4566839
Case Number EO-2015244-000253
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLINTON SCOTT MUSGRAVE MEMORIAL FUND
Organization’s Mailing Address 407 N APPLEKNOCKER ST
City COBDEN
State IL
ZIP 62920
Accounting period End 12
Primary contact name RANDY MUSGRAVE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANTHONY MUSGRAVE
PRESIDENT
407 N APPLEKNOCKER ST
COBDEN IL 62920

Officer/Director/Trustee Two

RANDY MUSGRAVE
TREASURE
215 APPLE LANE
ANNA IL 62906

Officer/Director/Trustee Three

JUDITH RAY
SECRETARY
215 APPLE LANE
ANNA IL 62906

Officer/Director/Trustee Four

RUSSEL ORSBURN
VICE PRESIDENT
290 CHECKOUT ST
ALTO PASS IL 62905

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/20/2015
Organization Incorporation State IL
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: 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 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
Signature Title
Signature Date

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