FORM 1023-EZ for THE 17TH CIRCUIT THERAPY DOG VOLUNTEERS INC

Field Data
EIN 83-2011858
Case Number EO-2019128-000139
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE 17TH CIRCUIT THERAPY DOG VOLUNTEERS INC
Organization’s Mailing Address 124 NORTH WATER STREET SUITE 206
City ROCKFORD
State IL
ZIP 61107
Accounting period End 8
Primary contact name KATHLEEN FINK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATHLEEN FINK
VICE PRESIDENT AND DIRECTOR
40
ROCKFORD IL 61108

Officer/Director/Trustee Two

AMANDA MEYERS
SECRETARY TREASURER DIRECTOR
321 KENILWORTH DRIVE
ROCKFORD IL 61101

Officer/Director/Trustee Three

BRUCE ERICKSON
PRESIDENT DIRECTOR
1058 PALAU PARKWAY
ROCKFORD IL 61008

Officer/Director/Trustee Four

MARY ELLEN COMMARE
DIRECTOR
8810 WINDING PRARIE TRAIL
BELVIDERE IL 61008

Officer/Director/Trustee Five

DARLENE HANNA
DIRECTOR
2137 CLINTON STREET
ROCKFORD IL 61103

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/22/18
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I01 - Alliance/Advocacy Organizations
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 BRUCE ERICKSON
Signature Title PRESIDENT DIRECTOR
Signature Date 5/6/19

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