FORM 1023-EZ for OZARK MOUNTAIN PET DISASTER RELIEF

Field Data
EIN 83-4492694
Case Number EO-2019114-000416
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name OZARK MOUNTAIN PET DISASTER RELIEF
Organization’s Mailing Address 148 PARADISE DRIVE
City ROGERSVILLE
State MO
ZIP 65742
Accounting period End 12
Primary contact name RON GIRTH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RON GIRTH
OFFICER/ PRESIDENT
148 PARADISE DRIVE
ROGERSVILLE MO 65742

Officer/Director/Trustee Two

BARBARA ALLEN
OFFICER/ VICE PRESIDENT
182 MC 7030
FLIPPEN AR 72634

Officer/Director/Trustee Three

SANDRA GIRTH
OFFICER/TREASURER
148 PARADISE DRIVE
ROGERSVILLE MO 65742

Officer/Director/Trustee Four

SHERRY GIBBANY POLOUS
OFFICER/SECRETARY
1483 HARDING BOULEVARD
COTTER AR 72626

Organization’s website
Organization’s email OMDISASTERRELIEF@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/19
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D11 - 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 Yes
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 RON GIRTH
Signature Title OFFICER/ PRESIDENT
Signature Date 4/22/19

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