FORM 1023-EZ for MIDORI BOUTIQUE INCORPORATED

Field Data
EIN 82-0694638
Case Number EO-2017081-000140
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MIDORI BOUTIQUE INCORPORATED
Organization’s Mailing Address 3792 JULIA LOOP
City EUGENE
State OR
ZIP 97404
Accounting period End 12
Primary contact name LEA HAMM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEA HAMM
CHAIRPERSON, SECRETARY, PRESIDENT
3792 JULIA LOOP
EUGENE OR 97404

Officer/Director/Trustee Two

MIKE HAMM
DIRECTOR, TREASURER
3792 JULIA LOOP
EUGENE OR 97404

Officer/Director/Trustee Three

KRISTY HAMMOND
DIRECTOR
3792 JULIA LOOP
EUGENE OR 97404

Officer/Director/Trustee Four

HEIDI HALL
DIRECTOR
3792 JULIA LOOP
EUGENE OR 97404

Officer/Director/Trustee Five

STEPHEN DAWSON
DIRECTOR
3792 JULIA LOOP
EUGENE OR 97404

Organization’s website WWW.MIDORIBOUTIQUE.ORG
Organization’s email CONTACT@MIDORIBOUTIQUE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/6/2017
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P29 - Thrift Shops
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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
Signature Title
Signature Date

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