FORM 1023-EZ for ADOPT AN INMATE

Field Data
EIN 81-2478932
Case Number EO-2020063-000124
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADOPT AN INMATE
Organization’s Mailing Address 25042 DUNHAM AVENUE SUITE 1543
City VENETA
State OR
ZIP 97487
Accounting period End 12
Primary contact name RICHARD WAYNE FISK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD FISK
CO-FOUNDER
88109 9TH STREET
VENETA OR 97487

Officer/Director/Trustee Two

MELISSA SCHMITT
SHE-EO
88109 9TH STREET
VENETA OR 97487

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/24/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: No
Religious: Yes
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 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 RICHARD FISK
Signature Title CO-FOUNDER
Signature Date 2/28/2020

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