FORM 1023-EZ for 12TH MOM INC

Field Data
EIN 85-3872006
Case Number EO-2020321-000560
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name 12TH MOM INC
Organization’s Mailing Address N5990 SHAW HILL ROAD
City BEAVER DAM
State WI
ZIP 53916
Accounting period End 12
Primary contact name ERIN BROOME
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIN BROOME
PRESIDENT & SECRETARY
313 WASHINGTON AVENUE S UNIT 1215
MINNNEAPOLIS MN 55415

Officer/Director/Trustee Two

RODNEY SHELTON JR
VICE PRESIDENT
736 E 16TH STREET UNIT 22
MINNEAPOLIS MN 55404

Officer/Director/Trustee Three

PEGGY BROOME
TREASURER
N5990 SHAW HILL ROAD
BEAVER DAM WI 53916

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/11/2020
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
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 ERIN BROOME
Signature Title PRESIDENT & SECRETARY
Signature Date 11/12/2020

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