FORM 1023-EZ for CULTIVATE INTERNATIONAL

Field Data
EIN 81-2626013
Case Number EO-2016155-000304
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CULTIVATE INTERNATIONAL
Organization’s Mailing Address 5354 PARKDALE DR STE 103
City ST LOUIS PARK
State MN
ZIP 55416
Accounting period End 12
Primary contact name JENNIFER URBAN - CAF NO 0308-14263R
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRAD TETZLOFF
PRESIDENT + DIRECTOR
5039 17TH AVE S
MINNEAPOLIS MN 55417

Officer/Director/Trustee Two

ELAINE TYMCHAK
TREASURER + DIRECTOR
17341 IDLEWOOD CT
LAKEVILLE MN 55044

Officer/Director/Trustee Three

JULIANNE RAATIKKA
SECRETARY + DIRECTOR
5415 XIMINES LN N
PLYMOUTH MN 55442

Officer/Director/Trustee Four

JENNIFER FREEMAN
DIRECTOR
258 WINIFRED ST W
ST PAUL MN 55107

Officer/Director/Trustee Five

PAUL ROBINSON
DIRECTOR
65 106TH AVE NW
COON RAPIDS MN 55448

Organization’s website CULTIVATEINTL.ORG
Organization’s email CULTIVATEINTL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/2016
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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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