FORM 1023-EZ for PROJECT XAVIER

Field Data
EIN 47-2466541
Case Number EO-2015166-000311
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PROJECT XAVIER
Organization’s Mailing Address 156 BLUEBIRD LN
City GRIDLEY
State CA
ZIP 95948
Accounting period End 6
Primary contact name ADAM BOWERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHANNON WALSH
DIRECTOR/PRESIDENT
1124 OREGON AVENUE
STEUBENVILLE OH 43952

Officer/Director/Trustee Two

CLAIRE MURRAY
TREASURER
3836 WARBLER DRIVE
ANTIOCH CA 94509

Officer/Director/Trustee Three

NICOLE MUHLENCAMP
SECRETARY
5011 SULLIVAN AVENUE
CINCINNATI OH 43952

Officer/Director/Trustee Four

ADAM BOWERS
DIRECTOR
156 BLUEBIRD LN
GRIDLEY CA 95948

Officer/Director/Trustee Five

DWITE BROWN
DIRECTOR
462-625 FIR WAY
WESTWOOD CA 96137-9407

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/2/2014
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X22 - Roman Catholic
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 Yes
Conducting Activities Outside of United States Yes
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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