FORM 1023-EZ for COUNTRY HEART SOUL

Field Data
EIN 81-3719131
Case Number EO-2016250-000068
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COUNTRY HEART SOUL
Organization’s Mailing Address 24917 WEST CHRISTINE DRIVE TRL 1
City SPLENDORA
State TX
ZIP 77372
Accounting period End 12
Primary contact name KATHERINE WASICEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHERINE WASICEK
PRESIDENT
24917 WEST CHRISTINE DRIVE TRL 1
SPLENDORA TX 77372

Officer/Director/Trustee Two

JOSHUA TYLER
TREASURE
15024 ZINC RD
SPLENDORA TX 77372

Officer/Director/Trustee Three

TAMMY HOLLOWAY
SECRETARY
15024 ZINC RD
SPLENDORA TX 77372

Organization’s website NA
Organization’s email COUNTRYHEARTANDSOUL2016@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/25/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T20 - Private Grantmaking Foundations
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 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
Signature Title
Signature Date

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