FORM 1023-EZ for RUSTIC RETREATS INC

Field Data
EIN 47-3445782
Case Number EO-2015093-000300
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RUSTIC RETREATS INC
Organization’s Mailing Address 3530 W ALLEN RD
City HOWELL
State MI
ZIP 48855
Accounting period End 12
Primary contact name LARRY FORSYTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LARRY FORSYTH
PRESIDENT
3530 W ALLEN RD
HOWELL MI 48855

Officer/Director/Trustee Two

MARY FORSYTH
SECRETARY
3530 W ALLEN RD
HOWELL MI 48855

Officer/Director/Trustee Three

JON WIERENGA
TREASURER
1775 DECKER RD
WALLED LAKE MI 48390

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/5/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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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