FORM 1023-EZ for PRESERVE BROADWATER HISTORY INC

Field Data
EIN 86-2494007
Case Number EO-2021096-001276
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PRESERVE BROADWATER HISTORY INC
Organization’s Mailing Address 53 BALDY VIEW LANE
City TOWNSEND
State MT
ZIP 59644
Accounting period End 12
Primary contact name VICTOR SAMPLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEITH KIRSCHER
PRESIDENT
41 BALDY VIEW LANE
TOWNSEND MT 59644

Officer/Director/Trustee Two

CHRISTOPHER WRIGHT
VICE PRESIDENT
41 SKY VIEW LANE
TOWNSEND MT 59644

Officer/Director/Trustee Three

VICTOR SAMPLE
SECRETARY-TREASURER
53 BALDY VIEW LANE
TOWNSEND MT 59644

Officer/Director/Trustee Four

PAMELA SAMPLE
DIRECTOR
53 BALDY VIEW LANE
TOWNSEND MT 59644

Officer/Director/Trustee Five

GARY RICHTMYER
DIRECTOR
16435 FALCON LANE
FLORENCE MT 59844

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/8/2021
Organization Incorporation State MT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A82 - Historical Preservation
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 VICTOR SAMPLE
Signature Title SECRETARY-TREASURER
Signature Date 3/9/2021

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