FORM 1023-EZ for ROB WITHERS SCHOLARSHIP INC

Field Data
EIN 47-3331991
Case Number EO-2016154-000306
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROB WITHERS SCHOLARSHIP INC
Organization’s Mailing Address 249 MAPLE LN
City MUNSTER
State IN
ZIP 46321
Accounting period End 12
Primary contact name WILLIAM DEKKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

WILLIAM DEKKER
INCORPORATOR
249 MAPLE LN
MUNSTER IN 46321

Officer/Director/Trustee Two

JAMES WILLIAMS
PRESIDENT
1010 GREAT PLAINS AVE
MATTESON IL 60443

Officer/Director/Trustee Three

HOLLY OLDENBURG
SECRETARY
1554 LAKEWOOD LN
SCHERERVILLE IN 46375

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/6/2015
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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
Signature Title
Signature Date

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