FORM 1023-EZ for NAMI MONROE COUNTY INC

Field Data
EIN 46-4863663
Case Number EO-2014237-000098
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NAMI MONROE COUNTY INC
Organization’s Mailing Address PO BOX 151
City TOMAH
State WI
ZIP 54660
Accounting period End 12
Primary contact name ERICA FALK-HUZAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ERICA FALK-HUZAR
PRESIDENT
23595 ELM AVENUE
TOMAH WI 54660

Officer/Director/Trustee Two

DIANE TODD
VICE PRESIDENT
1223 KILBOURN AVENUE
TOMAH WI 54660

Officer/Director/Trustee Three

NICOLE RAABE
SECRETARY
1411 NORTH SUPERIOR AVENUE
TOMAH WI 54660

Officer/Director/Trustee Four

BRENDA FALK-HUZAR
TREASURER
23595 ELM AVENUE
TOMAH WI 54660

Officer/Director/Trustee Five

SAMANTHA ESPINOSA
DIRECTOR
N7169 DUNNE CIRCLE
NEW LISBON WI 53950

Organization’s website WWW.NAMIMONROECOUNTY.ORG
Organization’s email INFO@NAMIMONROECOUNTY.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/8/2013
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
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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