FORM 1023-EZ for DARBY GRACYS DOG RESCUE

Field Data
EIN 47-2001553
Case Number EO-2014293-000052
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DARBY GRACYS DOG RESCUE
Organization’s Mailing Address 1200 SW MAIN STREET
City PORTLAND
State OR
ZIP 97025
Accounting period End 12
Primary contact name GREG HITCHCOCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHANNON ROWE
PRESIDENT
PO BOX 527
SHERWOOD OR 97140

Officer/Director/Trustee Two

GRACY DANFORTH
TREASURER
PO BOX 527
SHERWOOD OR 97140

Officer/Director/Trustee Three

LEANN BROWN
SECRETARY
PO BOX 527
SHERWOOD OR 97140

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/3/2014
Organization Incorporation State OR
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: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
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
Signature Title
Signature Date

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