FORM 1023-EZ for URBAN INDIAN 5 ASSOCIATION

Field Data
EIN 46-3847194
Case Number EO-2015126-000217
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name URBAN INDIAN 5 ASSOCIATION
Organization’s Mailing Address 1905 OAKMEADOWS DRIVE
City NORMAN
State OK
ZIP 73071-1209
Accounting period End 12
Primary contact name MARY BARSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

STEVE BARSE
EXECUTIVE DIRECTOR
1905 OAKMEADOWS DRIVE
NORMAN OK 73071-1209

Officer/Director/Trustee Two

MELISSA TRUEL-FALLON
VICE PRESIDENT
1805 SE 17TH STREET
MOORE OK 73160-7438

Officer/Director/Trustee Three

MARY BARSE
SEC/TREAS
1905 OAKMEADOWS DRIVE
NORMAN OK 73071-1209

Officer/Director/Trustee Four

WES WILSON
BOARD MEMBER
5100 156TH AVE NE
NEWALLA OK 74857-6421

Officer/Director/Trustee Five

CHEBON KERNELL
BOARD MEMBER
105 SW 133RD STREET
OKLAHOMA CITY OK 73170-1428

Organization’s website URBANINDIAN5.COM
Organization’s email M.BARSE@COX.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2015
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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