FORM 1023-EZ for LAKE PILLSBURY FIRE PROTECTION DISTRICT

Field Data
EIN 68-0431881
Case Number EO-2016110-000149
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKE PILLSBURY FIRE PROTECTION DISTRICT
Organization’s Mailing Address 29501 FULLER DRIVE UNIT B
City POTTER VALLEY
State CA
ZIP 95469
Accounting period End 6
Primary contact name CAROLYN WINN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRIS LOPEZ
DIRECTOR CHAIRMAN OF BOARD
5858 SINGING HILL ROAD
LIVERMORE CA 94550

Officer/Director/Trustee Two

RICK CUMMINGS
DIRECTOR
921 AMELIA COURT
WINDSOR CA 95492

Officer/Director/Trustee Three

DANNY FISH
DIRECTOR
PO BOX 5132
PETALUMA CA 94955

Officer/Director/Trustee Four

GREG BIAGI
DIRECTOR
1330 MANZANITA COURT
SANTA ROSA CA 95404

Officer/Director/Trustee Five

GORDON HASLER
DIRECTOR
809 MAPLE AVENUE
UKIAH CA 95482

Organization’s website
Organization’s email LAKEPILLSBURYFIREFIGHTERS@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/12/2001
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M24 - Fire Prevention, Protection, Control
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 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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