FORM 1023-EZ for CLEAN UP - GIVE BACK ORG

Field Data
EIN 82-4822640
Case Number EO-2018078-000522
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLEAN UP - GIVE BACK ORG
Organization’s Mailing Address 612 SOUTH 5TH AVENUE
City DES PLAINES
State IL
ZIP 60016
Accounting period End 12
Primary contact name DONNA ADAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONNA ADAM
PRESIDENT
612 SOUTH 5TH AVENUE
DES PLAINES IL 60016

Officer/Director/Trustee Two

BRUCE ADAM
VICE-PRESIDENT TREASURER
612 SOUTH 5TH AVENUE
DES PLAINES IL 60016

Officer/Director/Trustee Three

RENEE ADAM
SECRETARY
612 SOUTH 5TH AVENUE
DES PLAINES IL 60016

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/14/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T40 - Voluntarism Promotion
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 Yes
Donation of funds Yes
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 DONNA ADAM
Signature Title PRESIDENT
Signature Date 3/16/18

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