FORM 1023-EZ for MILLSTON AREA MUSEUM

Field Data
EIN 39-1790226
Case Number EO-2018008-000237
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MILLSTON AREA MUSEUM
Organization’s Mailing Address W2679 COUNTY ROAD HH
City WARRENS
State WI
ZIP 54666
Accounting period End 12
Primary contact name JENNIFER WALWORTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER WALWORTH
INITIAL DIRECTOR
W2679 COUNTY ROAD HH
WARRENS WI 54666

Officer/Director/Trustee Two

SARA HENDRICKS
INITIAL DIR/REGISTERED AGENT
317 NORTH SUPERIOR AVENUE
TOMAH WI 54660

Officer/Director/Trustee Three

DAVID WALWORTH
INITIAL DIRECTOR
W2679 COUNTY ROAD HH
WARRENS WI 54666

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/13/17
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
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 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 JENNIFER WALWORTH
Signature Title INITIAL DIRECTOR
Signature Date 1/5/18

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