FORM 1023-EZ for SIXTEEN 11 NAVAJO MISSION

Field Data
EIN 84-4961136
Case Number EO-2020065-000325
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SIXTEEN 11 NAVAJO MISSION
Organization’s Mailing Address 7385 DILLMAN RD
City CAMDEN
State OH
ZIP 45311-9675
Accounting period End 12
Primary contact name DAVE YOCOM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVE YOCOM
DIRECTOR
7385 DILLMAN RD
CAMDEN OH 45311-9675

Officer/Director/Trustee Two

MIKE ELLIOT
TRUSTEE
4641 OAKDELL AVE
DAYTON OH 45432-1520

Officer/Director/Trustee Three

MIKE RAGAN
TRUSTEE
52909 10 MILE RD
SOUTH LYON MI 48178-9757

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/24/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
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 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 DAVE YOCOM
Signature Title DIRECTOR
Signature Date 3/3/2020

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