FORM 1023-EZ for PROVIDENCE CEMETARY ASSOCIATION

Field Data
EIN 64-0910234
Case Number EO-2014224-000199
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PROVIDENCE CEMETARY ASSOCIATION
Organization’s Mailing Address 78 SYBIL MATIN DRIVE
City WAYNESBORO
State MS
ZIP 39367
Accounting period End 12
Primary contact name KATHERINE D WADDELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOUGLAS HUTTO
TRUSTEE
1071 CHICORA GREENE COUNTY ROAD
BUCKATUNNA MS 39322

Officer/Director/Trustee Two

KATHERINE WADDELL
TRUSTEE
78 SYBIL MARTIN DRIVE
WAYNESBORO MS 39367

Officer/Director/Trustee Three

ASHLEY DOUGLAS
TRUSTEE
65 ALICE STREET
WAYNESBORO MS 39367

Officer/Director/Trustee Four

WILLIAM MCINNIS
TRUSTEE
219 ALEX MCINNIS ROAD
STATE LINE MS 39362

Officer/Director/Trustee Five

DINAH HARDEE
TRUSTEE
P O BOX 615
WAYNESBORO MS 39367

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/1998
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y50 - Cemeteries, Burial Services
Organization’s purpose Charitable: No
Religious: Yes
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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