FORM 1023-EZ for LIVING PROOF MN

Field Data
EIN 84-2493495
Case Number EO-2019210-000362
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIVING PROOF MN
Organization’s Mailing Address 10106 CLINTON AVE S
City BLOOMINGTON
State MN
ZIP 55420
Accounting period End 12
Primary contact name SHIRA CHARPENTIER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIRA CHARPENTIER
PRESIDENT
10106 CLINTON AVE S
BLOOMINGTON MN 55420

Officer/Director/Trustee Two

TRACY CHARPENTIER
SECRETARY/TREASUERER
10106 CLINTON AVE S
BLOOMINGTON MN 55420

Organization’s website WWW.LIVINGPROOFMN.COM
Organization’s email SHIRA@LIVINGPROOFMN.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/19
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F53 - Eating Disorder, Addiction
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 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 SHIRA CHARPENTIER
Signature Title PRESIDENT
Signature Date 7/26/19

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