FORM 1023-EZ for NAMI TREMPEALEAU COUNTY INC

Field Data
EIN 47-5278884
Case Number EO-2016193-000470
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NAMI TREMPEALEAU COUNTY INC
Organization’s Mailing Address N20657 ROBINSON LANE
City ETTRICK
State WI
ZIP 54627
Accounting period End 12
Primary contact name ERICA ANDERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERICA ANDERSON
PRESIDENT
N20657 ROBINSON LANE
ETTRICK WI 54627

Officer/Director/Trustee Two

LAURA ENGLESBY
VICE PRESIDENT
125 KLINGMAN STREET
AUGUSTA WI 54722

Officer/Director/Trustee Three

RITA BOLAND
SECRETARY
N37714 STATE ROAD 93-121
INDEPENDENCE WI 54747

Officer/Director/Trustee Four

COURTNEY SMITH
OFFICER
STREET
ARCADIA WI 54612

Officer/Director/Trustee Five

JANE POPE
OFFICER
PO BOX 334
PIGEON FALLS WI 54760

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/17/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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