FORM 1023-EZ for PINE VALLEY NATIONAL HISTORICAL SOCIETY AND INSTITUTE

Field Data
EIN 72-1307931
Case Number EO-2020232-000101
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PINE VALLEY NATIONAL HISTORICAL SOCIETY AND INSTITUTE
Organization’s Mailing Address 17062 HOSSTON RODESSA ROAD
City RODESSA
State LA
ZIP 71069
Accounting period End 12
Primary contact name DOROTHY F JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DOROTHY JACKSON
PRESIDENT
7652 IBIZA DRIVE
BATON ROUGE LA 70820

Officer/Director/Trustee Two

BEVERLY WILSON
SECRETARY TREASURER
17702 RODESSA CHURCH ROAD
RODESSA LA 71069

Officer/Director/Trustee Three

CLAUDE JACKSON
DIRECTOR
17061 HOSSTON RODESSA ROAD
RODESSA LA 71069

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/13/1995
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
Organization’s purpose Charitable: Yes
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 Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DOROTHY JACKSON
Signature Title PRESIDENT
Signature Date 8/17/2020

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