FORM 1023-EZ for JACKSON TWP FIRE DEPT FOUNTAIN CO IN INC

Field Data
EIN 81-2617959
Case Number EO-2016141-000418
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name JACKSON TWP FIRE DEPT FOUNTAIN CO IN INC
Organization’s Mailing Address 3898 S SR 341
City HILLSBORO
State IN
ZIP 47949
Accounting period End 12
Primary contact name RICHARD HOLMES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL HARVEY
SECRETARY
3767 S SR 341
HILLSBORO IN 47949

Officer/Director/Trustee Two

NICK ELLINGWOOD
PRESIDENT
2409 E LUTHERAN CHURCH RD
HILLSBORO IN 47949

Officer/Director/Trustee Three

KEVIN SHOAF
DIRECTOR
3778 S SR 341
HILLSBORO IN 47949

Officer/Director/Trustee Four

SHARON RODGERS
DIRECTOR
3380 S RODGERS RD
HILLSBORO IN 47949

Officer/Director/Trustee Five

RICHARD HOLMES
INCORPORATOR
310 4TH ST
COVINGTON IN 47932

Organization’s website
Organization’s email RICHARD@RHOLMESLAW.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/13/2016
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M23 - Search and Rescue Squads, Services
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 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 Yes
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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