FORM 1023-EZ for PELHAM VALLEY FIRE AND RESCUE

Field Data
EIN 81-0840316
Case Number EO-2016146-000077
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PELHAM VALLEY FIRE AND RESCUE
Organization’s Mailing Address PO BOX 159
City PELHAM
State TN
ZIP 37366
Accounting period End 12
Primary contact name TRAVIS LAWYER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TRAVIS LAWYER
FIRE CHIEF / PRESIDENT
263 LOBOLLY LANE
PELHAM TN 37366

Officer/Director/Trustee Two

JEREMY BEAN
ASSISTANT CHIEF / VICE PRESIDENT
3301 US 41
PELHAM TN 37366

Officer/Director/Trustee Three

ZACH GALLAGHER
CAPTAIN / TREASURER
1279 US 41
PELHAM TN 37366

Officer/Director/Trustee Four

DAVID GALLAGHER
FIREFIGHTER / SECRETARY
1279 US 41
PELHAM TN 37366

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/24/1985
Organization Incorporation State TN
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 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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