FORM 1023-EZ for BETHLEHEM BAPTIST CHURCH

Field Data
EIN 80-0239408
Case Number EO-2016039-000154
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BETHLEHEM BAPTIST CHURCH
Organization’s Mailing Address 1801 N 35 ST
City MILWAUKEE
State WI
ZIP 53208
Accounting period End 12
Primary contact name DERRICK JACOBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DERRICK JACOBS
PRESIDENT
1801 N 35 ST
MILWAUKEE WI 53208

Officer/Director/Trustee Two

PAULA DURRELL
TRUSTEE
1801 N 35 ST
MILWAUKEE WI 53208

Organization’s website
Organization’s email DERRICKGJACOBS3888@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/21/2015
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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