FORM 1023-EZ for INTERNATIONAL CAMPAIGN FOR THE ROHINGYA

Field Data
EIN 81-4234076
Case Number EO-2017026-000151
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name INTERNATIONAL CAMPAIGN FOR THE ROHINGYA
Organization’s Mailing Address 950 N WASHINGTON ST
City ALEXANDRIA
State VA
ZIP 22314
Accounting period End 12
Primary contact name MARIANE LEITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH K GRIEBOSKI
CHAIRMAN, CEO
6178 CASTLETOWN WAY
ALEXANDRIA VA 22310

Officer/Director/Trustee Two

SIMON BILLENNESS
TREASURER, EXECUTIVE DIRECTOR
1403 F STREET NE
WASHINGTON DC 20002

Officer/Director/Trustee Three

OLIVIA DULMAGE
SECRETARY, OUTREACH DIRECTOR
2325 15TH STREET NW APT B11
WASHINGTON DC 20009

Officer/Director/Trustee Four

MARIANE LEITE
CHAIRPERSON, OPERATIONS DIRECTOR
1204 S WASHINGTON ST APT 827
ALEXANDRIA VA 22314

Officer/Director/Trustee Five

TRACY CASEY
CHAIRPERSON
6178 CASTLETOWN WAY
ALEXANDRIA VA 22310

Organization’s website ROHINGYACAMPAIGN.ORG
Organization’s email INFO@ROHINGYACAMPAIGN.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/16/2015
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q70 - International Human Rights
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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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