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        <State>TX</State>
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        <AddressLine1>2207 ST VINCENT COURT</AddressLine1>
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            <ZIPCode>80907</ZIPCode>
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          <PersonName referenceDocumentId="RetDoc3">CHRISTINE TESSAROWICZ</PersonName>
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            <AddressLine1>4070 SLEEPING INDIAN LN</AddressLine1>
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            <State>CO</State>
            <ZIPCode>80907</ZIPCode>
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          <Title>SECRETARY</Title>
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          <PersonName referenceDocumentId="RetDoc3">ALEC TESSAROWICZ</PersonName>
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          <PersonName referenceDocumentId="RetDoc3">LISA TESSAROWICZ</PersonName>
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        <CompOfHighestPaidEmplNONE>NONE</CompOfHighestPaidEmplNONE>
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            <City>COLORADO SPRINGS</City>
            <State>CO</State>
            <ZIPCode>80907</ZIPCode>
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          <RecipientPhoneNumber>7196417777</RecipientPhoneNumber>
          <FormAndInfoAndMaterials>NOT APPLICABLE</FormAndInfoAndMaterials>
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          <RecipientBusinessName>
            <BusinessNameLine1>ST MARGARET'S HOUSE</BusinessNameLine1>
          </RecipientBusinessName>
          <RecipientUSAddress>
            <AddressLine1>117 N LAFAYETTE BLVD</AddressLine1>
            <City>SOUTH BEND</City>
            <State>IN</State>
            <ZIPCode>46601</ZIPCode>
          </RecipientUSAddress>
          <PurposeOfGrantOrContribution>SHELTER FOR WOMEN AND CHILDREN</PurposeOfGrantOrContribution>
          <Amount>2500</Amount>
        </GrantOrContriPaidDuringYear>
        <GrantOrContriPaidDuringYear>
          <RecipientBusinessName>
            <BusinessNameLine1>CHEYENNE MOUNTAIN ZOO</BusinessNameLine1>
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            <AddressLine1>4250 CHEYENNE MOUNTAIN RD</AddressLine1>
            <City>COLORADO SPRINGS</City>
            <State>CO</State>
            <ZIPCode>80906</ZIPCode>
          </RecipientUSAddress>
          <PurposeOfGrantOrContribution>ZOOLOGICAL PARK</PurposeOfGrantOrContribution>
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        </GrantOrContriPaidDuringYear>
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        <ContributorNameIndividual>MICHAEL TESSAROWICZ</ContributorNameIndividual>
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          <AddressLine1>4070 SLEEPING INDIAN LANE</AddressLine1>
          <City>COLORADO SPRINGS</City>
          <State>CO</State>
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        <NoncashPropertyDescription>8500 SHS SOUTHERN COPPER STOCK</NoncashPropertyDescription>
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