FORM 1023-EZ for MICHIGAN FOR VACCINE CHOICE

Field Data
EIN 47-5401416
Case Number EO-2015306-000503
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MICHIGAN FOR VACCINE CHOICE
Organization’s Mailing Address 22615 FRANCIS STREET
City ST CLAIR SHORES
State MI
ZIP 48082-1791
Accounting period End 12
Primary contact name SUZANNE WALTMAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SUZANNE WALTMAN
PRESIDENT AND TREASURER
22615 FRANCIS STREET
ST CLAIR SHORES MI 48082-1791

Officer/Director/Trustee Two

JAMES PERKINS
VICE PRESIDENT
35502 JOHNSTOWN RD
FARMINGTON HILLS MI 48835-2014

Officer/Director/Trustee Three

SUSAN DAIZA
SECRETARY
5210 SERENA DR
TROY MI 48098-6204

Officer/Director/Trustee Four

MARY TOCCO
DIRECTOR
1731 INDIGO ISLAND DR
HANAHAN SC 29410-8576

Organization’s website
Organization’s email SUEMWALTMAN@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/23/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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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