FORM 1023-EZ for CIA SIAB INC

Field Data
EIN 81-3606765
Case Number EO-2016260-000196
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CIA SIAB INC
Organization’s Mailing Address 4915 NOTTINGHAM AVENUE
City LA CROSSE
State WI
ZIP 54601
Accounting period End 7
Primary contact name XONG XIONG
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

XONG XIONG
DIRECTOR
4915 NOTTINGHAM AVENUE
LA CROSSE WI 54601

Officer/Director/Trustee Two

MAI SHONA VANG
DIRECTOR
210 GREENO ROAD
HOLMEN WI 54636

Officer/Director/Trustee Three

PA HOMA VANG
DIRECTOR
3548 EAST AVENUE S APT C
LA CROSSE WI 54601

Officer/Director/Trustee Four

JAMIE KNUDTSON
DIRECTOR
2241 SAND LAKE ROAD
ONALASKA WI 54650

Officer/Director/Trustee Five

SHEESENPHOOYW MOUA
DIRECTOR
2001 SHAFER DRIVE
FITCHBURG WI 53711

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/15/2016
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P62 - Victims' Services
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 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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