FORM 1023-EZ for GRAVEL ROAD SOCIETY

Field Data
EIN 81-3413921
Case Number EO-2016222-000252
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GRAVEL ROAD SOCIETY
Organization’s Mailing Address C/O RICHARD BLACK / P O BOX 208
City MOOSE
State WY
ZIP 83012-0208
Accounting period End 12
Primary contact name RICHARD B BLACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THOMAS D MANGELSEN
PRESIDENT / CHAIRMAN / DIRECTOR
P O BOX 205 / FERN LANE
MOOSE WY 83012-0205

Officer/Director/Trustee Two

RICHARD B BLACK
TREASURER / DIRECTOR
P O BOX 2O8 /10655 UPPER MEADOW
MOOSE WY 83012-0208

Officer/Director/Trustee Three

MALINDA P CHOUINARD
V CHAIRMAN / DIRECTOR
4218 FARIA ROAD
VENTURA CA 93001

Officer/Director/Trustee Four

ERICA B PERIMAN
DIRECTOR
2012 COLFAX STREET
EVANSTON WY 60601

Officer/Director/Trustee Five

HEATHER B BLACK
SECRETARY / DIRECTOR
P O BOX 208 /10655 UPPER MEADOW
MOOSE WY 83012-0208

Organization’s website NONE
Organization’s email RBLACK@ECRM.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/29/2016
Organization Incorporation State WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C30 - Natural Resources Conservation and Protection
Organization’s purpose Charitable: Yes
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 No
One Third Support Gifts Yes
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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