FORM 1023-EZ for BROOKLYN LARSEN MEMORIAL FUND

Field Data
EIN 83-2005466
Case Number EO-2019042-000195
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BROOKLYN LARSEN MEMORIAL FUND
Organization’s Mailing Address PO BOX 213
City MILROY
State MN
ZIP 56263-213
Accounting period End 9
Primary contact name TONYA KLINKNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAMIE LARSEN
OFFICER
PO BOX 213
MILROY MN 56263-213

Officer/Director/Trustee Two

AMY LARSEN
OFFICER
PO BOX 213
MILROY MN 56263-213

Organization’s website
Organization’s email
Organization Incorporated
Organization trust Yes
Necessary Organizing Documents Yes
Organization Incorporation Date 10/26/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
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 No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity Yes
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 AMY LARSEN
Signature Title OFFICER
Signature Date 2/7/19

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