FORM 1023-EZ for MOZAYIK

Field Data
EIN 47-3872669
Case Number EO-2015127-000471
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOZAYIK
Organization’s Mailing Address 5301 WESTPORT RD APT 2
City MADISON
State WI
ZIP 53704
Accounting period End 12
Primary contact name CANDICE SCHNEIDER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CANDICE SCHNEIDER
PRESIDENT
5301 WESTPORT RD
MADISON WI 53704

Officer/Director/Trustee Two

MONA AUGUSTIN
VICE PRESIDENT
5301 WESTPORT RD
MADISON WI 53704

Officer/Director/Trustee Three

GREG CRONIN
TRUSTEE
4111 VEITH AVE
MADISON WI 53704

Officer/Director/Trustee Four

CARLA BLUNTCHLI
TRUSTEE
4111 VEITH AVE
MADISON WI 53704

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/15/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
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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