FORM 1023-EZ for STONE BANK FIRE EMS ASSOCIATION INC

Field Data
EIN 46-4456384
Case Number EO-2015216-000138
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STONE BANK FIRE EMS ASSOCIATION INC
Organization’s Mailing Address W335N7107 STONE BANK RD
City OCONOMOWOC
State WI
ZIP 53066-1407
Accounting period End 12
Primary contact name MARK BECKER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARK BECKER
PRESIDENT
W335N7027 STONE BANK RD
OCONOMOWOC WI 53066-1405

Officer/Director/Trustee Two

REBECCA PAUTSCH
BOARD MEMBER
N66W34415 TIMBERLINE RD
OCONOMOWOC WI 53066-5170

Officer/Director/Trustee Three

SUE SIMONS
BOARD MEMBER
W335N7011 STONE BANK RD
OCONOMOWOC WI 53066-1405

Officer/Director/Trustee Four

BROOKE PETERSON
BOARD MEMBER
W343N7205 NORTH POLE LANE
OCONOMOWC WI 53066-1366

Officer/Director/Trustee Five

STEVE TIDYMAN
BOARD MEMBER
W335N7107 STONE BANK RD
OCONOMOWOC WI 53066-1407

Organization’s website
Organization’s email STONEBANKFEA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/2014
Organization Incorporation State WI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T12 - Fund Raising and/or Fund Distribution
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
Signature Title
Signature Date

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