FORM 1023-EZ for PEMBERVILLE-FREEDOM FIRE DEPARTMENTASSOCIATION

Field Data
EIN 45-5378935
Case Number EO-2016285-000417
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEMBERVILLE-FREEDOM FIRE DEPARTMENTASSOCIATION
Organization’s Mailing Address 104 E FRONT STREET P O BOX 375
City PEMBERVILLE
State OH
ZIP 43450
Accounting period End 12
Primary contact name MICHAEL FRITZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHAD DIX
PRESIDENT
548 HICKORY STREET
PEMBERVILLE OH 43450

Officer/Director/Trustee Two

STEVE STOCHOVIAK
VICE PRESIDENT
445 MAPLE STREET
PEMBERVILLE OH 43450

Officer/Director/Trustee Three

CHARLENE PHILLIPS
SECRETARY
208 MARTIN AVENUE
PEMBERVILLE OH 43450

Officer/Director/Trustee Four

MICHAEL FRITZ
TREASURER
107 PERRY STREET
PEMBERVILLE OH 43450

Officer/Director/Trustee Five

JOHN VAUGHN
SARGENT AT ARMS
214 BOND STREET
PEMBERVILLE OH 43450

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2012
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M24 - Fire Prevention, Protection, Control
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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