FORM 1023-EZ for TRADITIONAL AMERICAN INDIAN SOCIETY

Field Data
EIN 81-3329433
Case Number EO-2017086-000394
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRADITIONAL AMERICAN INDIAN SOCIETY
Organization’s Mailing Address 829 ALPINO
City CIBOLO
State TX
ZIP 78108
Accounting period End 12
Primary contact name DANA MEDINA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LEONARD MEDINA
PRESIDENT
1612 JACKSON DRIVE
NORMAN OK 73071

Officer/Director/Trustee Two

DANA MEDINA
TREASURER
1612 JACKSON DRIVE
NORMAN OK 73071

Officer/Director/Trustee Three

EDWARD BLAUVELT
VICE PRESIDENT
829 ALPINO
CIBOLO TX 78108

Officer/Director/Trustee Four

ANASTASIA PIPIC
SECRETARY
12652 KING OAKS DRIVE
LIVE OAK TX 78108

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/29/2016
Organization Incorporation State TX
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: 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 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
Signature Title
Signature Date

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