FORM 1023-EZ for HERMITAGE ANIMAL RELIEF TEAM

Field Data
EIN 81-5145942
Case Number EO-2017040-000192
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HERMITAGE ANIMAL RELIEF TEAM
Organization’s Mailing Address 2000 STROMBURY DRIVE
City HERMITAGE
State TN
ZIP 37076
Accounting period End 12
Primary contact name KAYLA BUCKNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAYLA BUCKNER
PRESIDENT
2000 STROMBURY DRIVE
HERMITAGE TN 37076

Officer/Director/Trustee Two

ANN TEMPLE
SECRETARY
3041 GLENBORO DRIVE
HERMITAGE TN 37076

Officer/Director/Trustee Three

MELISSA KETELSEN
TREASURER
4913 LEESA ANN LANE
HERMITAGE TN 37076

Organization’s website WWW.HARTTN.ORG
Organization’s email HERMANIMALRELIEFTEAM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/19/2017
Organization Incorporation State TN
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: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
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
Signature Title
Signature Date

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