FORM 1023-EZ for PALISADES HISTORY MUSEUM INC

Field Data
EIN 86-2271874
Case Number EO-2021250-000270
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PALISADES HISTORY MUSEUM INC
Organization’s Mailing Address PO BOX 40105
City WASHINGTON
State DC
ZIP 20016
Accounting period End 12
Primary contact name PATRICK SHAUGHNESS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK SHAUGHNESS
SECRETARY-TREASURER DIR
PO BOX 40105
WASHINGTON DC 20016

Officer/Director/Trustee Two

ALEX F KNOTT AGRAWAL
PRESIDENT DIRECTOR
PO BOX 40105
WASHINGTON DC 20016

Officer/Director/Trustee Three

DOUG DUPIN
DIRECTOR
PO BOX 40105
WASHINGTON DC 20016

Organization’s website PALISADESHISTORY.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/7/2021
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A54 - History Museums
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 Yes
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 No
Signature Name PATRICK SHAUGHNESS
Signature Title SECRETARY-TREASURER DIR
Signature Date 9/2/2021

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