FORM 1023-EZ for JEFFERSON LIVE MUSIC FOUNDATION INC

Field Data
EIN 47-2844907
Case Number EO-2017093-000082
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JEFFERSON LIVE MUSIC FOUNDATION INC
Organization’s Mailing Address 309 S MAIN STREET
City JEFFERSON
State WI
ZIP 53549
Accounting period End 12
Primary contact name NICHOLAS J ANSAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KYLE TULLY
PRESIDENT, DIRECTOR
524 E NORTH STREET
JEFFERSON WI 53549

Officer/Director/Trustee Two

CINDY WADE
TREASURER, DIRECTOR
835 GARITY STREET
JEFFERSON WI 53549

Officer/Director/Trustee Three

AMANDA DAMP
SECRETARY, DIRECTOR
650 RIVERVIEW COURT
JEFFERSON WI 53549

Officer/Director/Trustee Four

JOANN MILLER
DIRECTOR
1157 HILLEBRAND DRIVE
JEFFERSON WI 53549

Officer/Director/Trustee Five

NICHOLAS ANSAY
DIRECTOR
780 MEADOWVIEW LANE
JOHNSON CREEK WI 53038

Organization’s website JEFFERSONLIVEMUSIC.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/2/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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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