FORM 1023-EZ for HOUSE OF SAMUEL

Field Data
EIN 82-2900394
Case Number EO-2017271-000266
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOUSE OF SAMUEL
Organization’s Mailing Address 402 N CHESTNUT ST
City RICHLAND
State MO
ZIP 65556
Accounting period End 12
Primary contact name HANNAH MARCHBANK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HANNAH MARCHBANK
DIRECTOR
402 N CHESTNUT ST
RICHLAND MO 65556

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/26/2017
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
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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