FORM 1023-EZ for THOMAS JEFFERSON EMS TASK FORCE 2

Field Data
EIN 61-1849535
Case Number EO-2018197-000531
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THOMAS JEFFERSON EMS TASK FORCE 2
Organization’s Mailing Address 743 OLD APPLE GROVE ROAD
City MINERAL
State VA
ZIP 23117-3006
Accounting period End 12
Primary contact name DONNA BURNS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DONNA BURNS
DIRECTOR
743 OLD APPLE GROVE ROAD
MINERAL VA 23117-3006

Officer/Director/Trustee Two

KOSTAS ALIBERTIS
DIRECTOR
1265 CROZET AVENUE
CROZET VA 22932

Officer/Director/Trustee Three

CURTIS SHEETS
DIRECTOR
PO BOX 711
NELLYSFORD VA 22958

Organization’s website NA
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/14/17
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M99 - Public Safety, Disaster Preparedness, and Relief N.E.C.
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 Yes
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 DONNA BURNS
Signature Title DIRECTOR
Signature Date 7/14/18

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