FORM 1023-EZ for LIBERTY BRANCH VOLUNTEER FIRE DEPARTMENT

Field Data
EIN 36-4456041
Case Number EO-2015131-000267
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIBERTY BRANCH VOLUNTEER FIRE DEPARTMENT
Organization’s Mailing Address 435 HIGHWAY 481
City PELAHATCHIE
State MS
ZIP 39145
Accounting period End 12
Primary contact name KATHY NAZARY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

KATHY NAZARY
BOARD PRESIDENT
137 FLEMING ROAD
PELAHATCHIE MS 39145

Officer/Director/Trustee Two

BERNARD KING
BOARD MEMBER
251 RED OAK ROAD
PELAHATCHIE MS 39145

Officer/Director/Trustee Three

SAM WILSON
BOARD MEMBER
704 RED OAK ROAD
PELAHATCHIE MS 39145

Officer/Director/Trustee Four

JERRY JONES
BOARD MEMBER
610 HIGHWAY 481
PELAHATCHIE MS 39145

Officer/Director/Trustee Five

DWIGHT IRBY
BOARD MEMBER
544 LINE PRAIRIE ROAD
MORTON MS 39117

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/9/1998
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S32 - Rural Development
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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