FORM 1023-EZ for BLACK HISTORY MUSEUM OF WARREN COUNTY TENNESSEE

Field Data
EIN 84-2797583
Case Number EO-2019241-000285
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK HISTORY MUSEUM OF WARREN COUNTY TENNESSEE
Organization’s Mailing Address PO BOX 7319
City MC MINNVILLE
State TN
ZIP 37111
Accounting period End 12
Primary contact name ANGELA L MCCORMACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WAYNE R WOLFORD SR
DIRECTOR
277 BOLDEN GREEN RD
MC MINNVILLE TN 37110

Officer/Director/Trustee Two

MARY V WOLFORD
SECRETARY
277 BOLDEN GREEN RD
MC MINNVILLE TN 37110

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/19
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A82 - Historical Preservation
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name WAYNE R WOLFORD SR
Signature Title DIRECTOR
Signature Date 8/27/19

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