FORM 1023-EZ for OLD CLIFTY MEMORIAL ASSOCIATION INC

Field Data
EIN 81-3179782
Case Number EO-2016193-000574
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OLD CLIFTY MEMORIAL ASSOCIATION INC
Organization’s Mailing Address 3088 S OLD CLIFTY ROAD
City BLOOMFIELD
State IN
ZIP 47424
Accounting period End 12
Primary contact name DAVID WASHBURN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID WASHBURN
PRESIDENT
9335 E SPRUCE ROAD
BLOOMFIELD IN 47424

Officer/Director/Trustee Two

THOMAS JOCHIM
VICE PRESIDENT
10378 E SPRING HILL ROAD
BLOOMFIELD IN 47424

Officer/Director/Trustee Three

PAUL TRAMPKE
SECRETARY
3347 S OLD CLIFTY ROAD
BLOOMFIELD IN 47424

Officer/Director/Trustee Four

ANITA WILDMAN-MEANS
TREASURER
519 DOGWOOD HILL
LOOGOOTEE IN 47553

Officer/Director/Trustee Five

THERESA ANDIS
BOARD MEMBER
247 W MAIN ST
BLOOMFIELD IN 47424

Organization’s website
Organization’s email OLDCLIFTYCHURCH@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/8/2016
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W11 - Single Organization Support
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 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
Signature Title
Signature Date

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