FORM 1023-EZ for BUCKNER PLACE INC

Field Data
EIN 26-2065551
Case Number EO-2015096-000344
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BUCKNER PLACE INC
Organization’s Mailing Address 4120 ANSAR LN
City INDIANAPOLIS
State IN
ZIP 46254
Accounting period End 12
Primary contact name LAURIE BUCKNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LAURIE BUCKNER
EX. DIRECTOR
4120 ANSAR LN
INDIANAPOLIS IN 46254

Officer/Director/Trustee Two

JANNELL WATSON
DIRECTOR
6620 HOLLOW RUN
INDIANAPOLIS IN 46214

Officer/Director/Trustee Three

FRITZ JOHNSON
DIRECTOR
2610 WESTLANE
INDIANAPOLIS IN 46268

Officer/Director/Trustee Four

MARYLYNN BERRY-STAMM
DIRECTOR
585 BECKER CT
ZIONSVILLE IN 46077

Officer/Director/Trustee Five

ILLENE MORRIS
DIRECTOR
3608 N CAPITAL
INDIANAPOLIS IN 46208

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/2010
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F33 - Group Home, Residential Treatment Facility - Mental Health Related
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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