FORM 1023-EZ for THE FARM SENIOR DOG SANCTUARY INCORPORATED

Field Data
EIN 84-2508628
Case Number EO-2019241-000348
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE FARM SENIOR DOG SANCTUARY INCORPORATED
Organization’s Mailing Address 469 COUNTY ROAD 21
City CERESCO
State NE
ZIP 68017
Accounting period End 12
Primary contact name JOHN HAVERKAMP
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSHUA BOMBERGER
PRESIDENT
469 COUNTY ROAD 21
CERESCO NE 68017

Officer/Director/Trustee Two

SHAWNA CLEMENT
VICE PRESIDENT
469 COUNTY ROAD 21
CERESCO NE 68017

Officer/Director/Trustee Three

JOHN HAVERKAMP
SECRETARY AND TREASURER
12829 WEST DODGE ROAD STE 201
OMAHA NE 68154

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/24/19
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
Religious: No
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 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 JOHN HAVERKAMP
Signature Title SECRETARY AND TREASURER
Signature Date 8/27/19

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