FORM 1023-EZ for COUNTY MOUNTIES

Field Data
EIN 47-4794604
Case Number EO-2016183-000095
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COUNTY MOUNTIES
Organization’s Mailing Address 136 ISLAND DRIVE
City HENDERSONVILLE
State TN
ZIP 37075
Accounting period End 12
Primary contact name SEAN ROACH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RON CHLASTA
PRESIDENT
136 ISLAND DRIVE
HENDERSONVILLE TN 37075

Officer/Director/Trustee Two

JASON PARIZEK
TREASURER
101 CLARENDON PLACE
HENDERSONVILLE TN 37075

Officer/Director/Trustee Three

SEAN ROACH
DIRECTOR
PO BOX 619
HENDERSONVILLE TN 37077-0619

Officer/Director/Trustee Four

ANNE WEEKES
DIRECTOR
6980 TATER PEELER RD
LEBANON TN 37090

Officer/Director/Trustee Five

JENNY CLYMER
DIRECTOR
1391 BECKWITH RD
MT JULIET TN 37122

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2015
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M23 - Search and Rescue Squads, 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
Signature Title
Signature Date

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