FORM 1023-EZ for PAWS OF ADAMS COUNTY

Field Data
EIN 45-5251809
Case Number EO-2015156-000104
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PAWS OF ADAMS COUNTY
Organization’s Mailing Address 1310 MASTER DRIVE
City DECATUR
State IN
ZIP 46733
Accounting period End 12
Primary contact name CODY R WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MIRANDA MERTZ
PRESIDENT
1310 MASTER DRIVE
DECATUR IN 46733

Officer/Director/Trustee Two

PATTY DANIELS
VICE PRESIDENT
9599 N 300 W
DECATUR IN 46733

Officer/Director/Trustee Three

ANDREA BYER
SECRETARY
1021 MASTER DRIVE
DECATUR IN 46733

Officer/Director/Trustee Four

CANDACE TACKETT
TREASURER
218 W FRANKLIN STREET
BERNE IN 46711

Officer/Director/Trustee Five

VICKI DECAMP
BOARD MEMBER
1106 E PAULDING ROAD
FORT WAYNE IN 46816

Organization’s website
Organization’s email ADAMSCOUNTYANIMALS@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/9/2015
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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