FORM 1023-EZ for HARVEYS LAKE FIRE & AMBULANCE ASSOCIATION

Field Data
EIN 86-3640843
Case Number EO-2021179-000616
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HARVEYS LAKE FIRE & AMBULANCE ASSOCIATION
Organization’s Mailing Address 1349 LAKESIDE DRIVE
City HARVEYS LAKE
State PA
ZIP 18618
Accounting period End 12
Primary contact name ROBERT CHRISTIAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JARID DIETTERICH
PRES
15 PINE ST
HARVEYS LAKE PA 18618

Officer/Director/Trustee Two

CHARLES WEST
VICE PRES
30 ANNABELLE AVE
HARVEYS LAKE PA 18618

Officer/Director/Trustee Three

FRANK LUTINSKI
2ND VICE PRES
10 OAK ST
HARVEYS LAKE PA 18618

Officer/Director/Trustee Four

KRISTINE GILLEN
RECORDING SECRETARY
243 PACI HILL RD
NOXEN PA 18636

Officer/Director/Trustee Five

ALLYSON BARCHESKI
SECRETARY TREASURER
38 SOOBY AVE
HARVEYS LAKE PA 18618

Organization’s website WWW.HARVEYSLAKEFIRE-AMB.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/4/2021
Organization Incorporation State PA
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 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 ALLYSON BARCHESKI
Signature Title SECRETARY TREASURER
Signature Date 6/25/2021

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