FORM 1023-EZ for OVERDOSE AWARENESS MEMORIAL OF LIVINGSTON COUNTY ILLINOIS

Field Data
EIN 81-4928764
Case Number EO-2017017-000518
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OVERDOSE AWARENESS MEMORIAL OF LIVINGSTON COUNTY ILLINOIS
Organization’s Mailing Address 714 NORTH LEONA LANE
City FORREST
State IL
ZIP 61741
Accounting period End 12
Primary contact name BRANDY PEKAROVICH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRANDY PEKAROVICH
PRESIDENT
714 NORTH LEONA LANE
FORREST IL 61741

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/13/2017
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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