FORM 1023-EZ for LAKE BUTLER ANIMAL RESCUE INC

Field Data
EIN 83-3985243
Case Number EO-2019176-000196
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE BUTLER ANIMAL RESCUE INC
Organization’s Mailing Address 497 SW SUNDAY GLEN
City LAKE CITY
State FL
ZIP 32024
Accounting period End 12
Primary contact name NANCY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NANCY KETTERLING
PRESIDENT
497 SW SUNDAY GLEN
LAKE CITY FL 32024

Officer/Director/Trustee Two

MICHELLE MARQUET
VICE PRESIDENT
3368 WEST CR 238
LAKE BUTLER FL 32054

Officer/Director/Trustee Three

LAURIE LOPEZ
SECERTARY
16390 SE 71 TRAIL
LAKE BUTLER FL 32054

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/15/19
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D12 - Fund Raising and/or Fund Distribution
Organization’s purpose Charitable: Yes
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 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 NANCY KETTERLING
Signature Title PRESIDENT
Signature Date 6/20/19

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