FORM 1023-EZ for HOUSE OF LEYBOURN

Field Data
EIN 83-1177161
Case Number EO-2018232-000497
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HOUSE OF LEYBOURN
Organization’s Mailing Address 688 FREBIS AVE
City COLUMBUS
State OH
ZIP 43206
Accounting period End 6
Primary contact name BRENT DICKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRENT DICKSON
EXECUTIVE DIRECTOR
688 FREBIS AVE
COLUMBUS OH 43206

Officer/Director/Trustee Two

CAROL JANSSEN
PRESIDENT
325 E STRATFORD LN
APPLETON WI 54913

Officer/Director/Trustee Three

JOANNE SMITH
BOARD MEMBER
1033 SATURN DR
TOLEDO OH 43615

Organization’s website HTTP://WWW.HOUSEOFLEYBOURN.COM
Organization’s email BRENTDICKSON@HOUSEOFLEYBOURN.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/11/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A80 - Historical Societies, Related Historical Activities
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 BRENT DICKSON
Signature Title EXECUTIVE DIRECTOR
Signature Date 8/17/18

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