FORM 1023-EZ for BELVIDERE VETERANS MEMORIAL PARK INC

Field Data
EIN 81-5326090
Case Number EO-2017076-000141
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BELVIDERE VETERANS MEMORIAL PARK INC
Organization’s Mailing Address 115 S RAILROAD ST PO BOX 106
City SIX LAKES
State MI
ZIP 48886-0106
Accounting period End 12
Primary contact name ORA V BURGGREN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ORA BURGGREN
CHAIRMAN
111 N CLARK ST PO BOX 56
SIX LAKES MI 48886-0106

Officer/Director/Trustee Two

CARRIE PETERMAN
VICE CHAIRMAN
2715 DALE DR
SIX LAKES MI 48886

Officer/Director/Trustee Three

DAVID SKUTT
FINANCIAL OFFICER
1380 JUDY DR PO BOX 71
SIX LAKES MI 48886-0071

Officer/Director/Trustee Four

JAIME HUBER
SECRETARY
1036 N BAILEY DR
STANTON MI 48888

Officer/Director/Trustee Five

CYNTHIA FLETCHER
VICE SECRETARY
9980 TINYS TRAIL PO BOX 44
SIX LAKES MI 48886-0044

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/2/2017
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N32 - Parks and Playgrounds
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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