FORM 1023-EZ for FAIRFIELD FOOD PANTRY INC

Field Data
EIN 47-2448490
Case Number EO-2014340-000197
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAIRFIELD FOOD PANTRY INC
Organization’s Mailing Address 64985 COUNTY RD 33
City GOSHEN
State IN
ZIP 46528
Accounting period End 12
Primary contact name SANDY SIZEMORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RAYMOND ADLER
ATTY
136 S 9TH
NOBLESVILLE IN 46060-2614

Officer/Director/Trustee Two

CAROLYN LEFVRE
INCORPORATOR
1320 GREEN CROFT DR
GOSHEN IN 46256

Officer/Director/Trustee Three

STEVEN BIRKLEY
INCORPORATOR
219 TRAVIS COURT
MILLERSBURG IN 46543

Officer/Director/Trustee Four

TIM WAITS
INCORPORATOR
68515 COUNTY RD 31
GOSHEN IN 46526

Officer/Director/Trustee Five

VICKI BECKER
INCORPORATOR
71025 COUNTY RD 25
NEW PARIS IN 46553

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/17/2014
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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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