FORM 1023-EZ for CLAIMING YOUR ROOTS

Field Data
EIN 82-5151504
Case Number EO-2018128-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLAIMING YOUR ROOTS
Organization’s Mailing Address 4202 N EMS BLVD SUITE 180-1
City GREENFIELD
State IA
ZIP 46140
Accounting period End 12
Primary contact name DAWN EVANS-CASEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAWN EVANS-CASEY
CEO / DIRECTOR
1313 GLENEAGLE DRIVE
INDIANAPOLIS IN 46239

Officer/Director/Trustee Two

CHARLES CASEY
DIRECTOR
1313 GLENEAGLE DRIVE
INDIANAPOLIS IN 46239

Officer/Director/Trustee Three

MICHELLE CAIN WRIGHT
DIRECTOR
6030 SYCAMORE FORGE LANE
INDIANAPOLIS IN 46254

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/15/18
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
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 Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DAWN EVANS-CASEY
Signature Title CEO / DIRECTOR
Signature Date 4/30/18

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