FORM 1023-EZ for WILDLIFE REPAIR SHOP

Field Data
EIN 83-3809055
Case Number EO-2019065-000259
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name WILDLIFE REPAIR SHOP
Organization’s Mailing Address 17029 PINEVIEW DRIVE
City HOMER GLEN
State IL
ZIP 60491
Accounting period End 2
Primary contact name ALISON M PETERS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALISON M PETERS
CHIEF OPERATING OFFICER
17029 PINEVIEW DRIVE
HOMER GLEN IL 60491

Officer/Director/Trustee Two

BRIAN J PETERS
PRESIDENT
17029 PINEVIEW DRIVE
HOMER GLEN IL 60491

Officer/Director/Trustee Three

LISA A HAVERTY
TRUSTEE
17029 PINEVIEW DRIVE
HOMER GLEN IL 60491

Organization’s website WILDLIFEREPAIRSHOP.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/19
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D40 - Veterinary Services
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 ALISON M PETERS
Signature Title CHIEF OPERATING OFFICER
Signature Date 3/4/19

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