FORM 1023-EZ for ANDOVER HISTORICAL SOCIETY

Field Data
EIN 32-0305807
Case Number EO-2017124-000211
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ANDOVER HISTORICAL SOCIETY
Organization’s Mailing Address PO BOX 66
City ANDOVER
State NY
ZIP 14806
Accounting period End 12
Primary contact name DAVID SCHAUT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EVELYN SMITH
PRESIDENT
1586 DYKE ROAD
ANDOVER NY 14806

Officer/Director/Trustee Two

HATTIE GAVIN
VICE-PRESIDENT
3844 SWAIN HILL ROAD
ANDOVER NY 14806

Officer/Director/Trustee Three

RUTH MANSKE
SECRETARY
16 EAST CENTER ST
A NY 14806

Officer/Director/Trustee Four

DAVID SCHAUT
TREASURER
2323 COUNTY ROAD 22
ANDOVER NY 14806

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/18/2012
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A80 - Historical Societies, Related Historical Activities
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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