FORM 1023-EZ for TERRY MIKESKA FOUNDATION

Field Data
EIN 81-1887453
Case Number EO-2016144-000248
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TERRY MIKESKA FOUNDATION
Organization’s Mailing Address PO BOX 61692
City SAN ANGELO
State TX
ZIP 76906
Accounting period End 12
Primary contact name HAROLD W SHELBURNE CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TERRY MIKESKA
PRESIDENT
2197 CLUB HOUSE LANE
SAN ANGELO TX 76904

Officer/Director/Trustee Two

CHANDLER MIKESKA
VICE-PRESIDENT
2197 CLUB HOUSE LANE
SAN ANGELO TX 76904

Officer/Director/Trustee Three

HAROLD W SHELBURNE
SECRETARY
3177 EXECUTIVE DR
SAN ANGELO TX 76904

Officer/Director/Trustee Four

HAROLD W SHELBURNE
TREASURER
3177 EXECUTIVE DR
SAN ANGELO TX 76904

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 Yes
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 Yes
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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