FORM 1023-EZ for STATE LINE ANIMAL HOSPITAL KENNEL

Field Data
EIN 81-1629095
Case Number EO-2016029-000287
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STATE LINE ANIMAL HOSPITAL KENNEL
Organization’s Mailing Address 2009 W 104TH STREET
City LEAWOOD
State KS
ZIP 66206
Accounting period End 12
Primary contact name JENI HORTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SALLY BARCHMAN
OWNER
7708 W 96TH STREET
OVERLAND PARK KS 66212

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2014
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D40 - Veterinary Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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