FORM 1023-EZ for MOUNT HOREB HISTORICAL SOCIETY INC

Field Data
EIN 86-1112028
Case Number EO-2015293-000063
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOUNT HOREB HISTORICAL SOCIETY INC
Organization’s Mailing Address 19644 DURANGO DRIVE C/O NORDWALD
City WARRENTON
State MO
ZIP 63383
Accounting period End 7
Primary contact name DAN BOTHE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DAN BOTHE
TRUSTEE
4262 HORSESHOE CREEK DRIVE
ST. CHARLES MO 63304

Officer/Director/Trustee Two

LARRY TATE
TRUSTEE
9119 COUNTY ROAD 389
NEW BLOOMFIELD MO 65039

Officer/Director/Trustee Three

JOE INCHIOSTRO
TRUSTEE
65 INKY LANE
MONTGOMERY CITY MO 63361

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/2004
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A80 - Historical Societies, Related Historical Activities
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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