FORM 1023-EZ for OSAGE VALLEY DOMESTIC ANIMAL SHELTER

Field Data
EIN 47-5478799
Case Number EO-2015310-000069
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name OSAGE VALLEY DOMESTIC ANIMAL SHELTER
Organization’s Mailing Address 20866 TWIN HILLS DR
City WARSAW
State MO
ZIP 65355-0004
Accounting period End 6
Primary contact name KIMBERLY MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AMY SPAUNAGLE
FINANCE
944 REDBUD ST
WARSAW MO 65355

Officer/Director/Trustee Two

MILINDA WILLIAMS
SECRATARY
28964 RULE AVE
WARSAW MO 65355

Officer/Director/Trustee Three

KOLBIE SAERFIELD
MARKETING
15369 COUNTY ROAD 448
ST. JAMES MO 65559

Officer/Director/Trustee Four

KIMBERLY MILLER
ORGINIZER
20866 TWIN HILLS DR
WARSAW MO 65355

Organization’s website
Organization’s email OSAGEVALLEYSHELTER@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/3/2015
Organization Incorporation State MO
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: No
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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