FORM 1023-EZ for NATURAL STATE BURIAL ASSOCIATION

Field Data
EIN 47-5249881
Case Number EO-2016021-000408
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name NATURAL STATE BURIAL ASSOCIATION
Organization’s Mailing Address PO BOX 2944
City FAYETTEVILLE
State AR
ZIP 72702-2944
Accounting period End 12
Primary contact name JAMES THOMAS DUREKA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GRETA ALLENDORF
PRESIDENT
317 E HUNTSVILLE RD
FAYETTVEILLE AR 72701

Officer/Director/Trustee Two

STEPHEN VALLUS
OFFICER
747 N WASHINGTON
FAYETTEVILLE AR 72701

Officer/Director/Trustee Three

JAMES DUREKA
OFFICER
19 W PIKE ST
FAYETTEVILLE AR 72701

Officer/Director/Trustee Four

VICKIE KELLY
OFFICER
PO BOX 155
ELKINS AR 72727

Officer/Director/Trustee Five

EHTAN REESE-WHITING
VICE PRESIDENT
3144 PARKWAY DRIVE
FAYETTEVILLE AR 72704

Organization’s website NATURALSTATEBURIALASSOCIATION.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/2015
Organization Incorporation State AR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y50 - Cemeteries, Burial Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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
Signature Title
Signature Date

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