FORM 1023-EZ for LAWTON AMBULANCE INC

Field Data
EIN 42-1369049
Case Number EO-2018193-000418
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAWTON AMBULANCE INC
Organization’s Mailing Address 104 W MAPLE STREET
City LAWTON
State IA
ZIP 51030
Accounting period End 12
Primary contact name KEN EYERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEN EYERS
DIRECTOR
301 E MAIN STREET
LAWTON IA 51030

Officer/Director/Trustee Two

KIM NEWMAN
DIRECTOR
319 E MAIN STREET
LAWTON IA 51030

Officer/Director/Trustee Three

DOUG BOETGER
DIRECTOR
99 WALNUT STREET
LAWTON IA 51030

Officer/Director/Trustee Four

SALLY MCMAHON
DIRECTOR
1550 110TH STREET
SIOUX CITY IA 51108

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/18
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M11 - 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 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 KEN EYERS
Signature Title DIRECTOR
Signature Date 7/10/18

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