FORM 1023-EZ for GIVE BACK PROGRAM INC

Field Data
EIN 38-3986208
Case Number EO-2016235-000315
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GIVE BACK PROGRAM INC
Organization’s Mailing Address 3060 SOUTHWORTH ROAD
City DELPHOS
State OH
ZIP 45833
Accounting period End 12
Primary contact name LYNN MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LYNN MILLER
DIRECTOR
3060 SOUTHWORTH ROAD
DELPHOS OH 45833

Officer/Director/Trustee Two

DOROTHY MILLER
DIRECTOR
5025 N KILL ROAD
DELPHOS OH 45833

Officer/Director/Trustee Three

DONALD MILLER
DIRECTOR
5025 N KILL ROAD
DELPHOS OH 45833

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/3/2015
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition N.E.C.
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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