FORM 1023-EZ for REPRESENTATIVE INC

Field Data
EIN 87-1057302
Case Number EO-2021175-000023
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REPRESENTATIVE INC
Organization’s Mailing Address 2019 MITCHELL STREET
City OSHKOSH
State WI
ZIP 54901
Accounting period End 12
Primary contact name AMY FARLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AMY FARLEY
PRESIDENT
2019 MITCHELL STREET
OSHKOSH WI 54901

Officer/Director/Trustee Two

BRITTANY WAGNER
VICE-PRESIDENT
110 LORAINE COURT
RIDGEWAY WI 53048

Officer/Director/Trustee Three

TAMMY SCHNEIDERVIN
SECRETARY
736 MAIN STREET
LOMIRA WI 53048

Officer/Director/Trustee Four

SHANE MURPHY
TREASURER
520 E SAIN MARY STREET
MILTON WI 53563

Organization’s website
Organization’s email AMY_FARLEY@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/7/2021
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social 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 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 Yes
Signature Name AMY FARLEY
Signature Title PRESIDENT
Signature Date 6/21/2021

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