FORM 1023-EZ for CHS MEMORIAL STONE

Field Data
EIN 46-3449241
Case Number EO-2015252-000139
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHS MEMORIAL STONE
Organization’s Mailing Address PO BOX 531632
City HENDERSON
State NV
ZIP 89053
Accounting period End 10
Primary contact name TRACY ELVIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AUBURNE GALLAGHER
CEO
14009 LAYNE LP
LEANDER TX 78641

Officer/Director/Trustee Two

TRACY ELVIN
COO
6687 PRESTO CT
LAS VEGAS NV 89139

Officer/Director/Trustee Three

PATTI PERLOWIN WEST
CFO
161 ALTERRA DRIVE
HENDERSON NV 89074

Officer/Director/Trustee Four

L SCOTT ZABRINSKI
CTO
543 LAKE CHARLES ST
NORTH LAS VEGAS NV 89031

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/2014
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T11 - Single Organization Support
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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