FORM 1023-EZ for SPAY CAMPBELL COUNTY TENNESSEE PETS

Field Data
EIN 81-1545343
Case Number EO-2016074-000246
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SPAY CAMPBELL COUNTY TENNESSEE PETS
Organization’s Mailing Address P O BOX 644
City LA FOLLETTE
State TN
ZIP 37766
Accounting period End 6
Primary contact name DEBORAH PEMBERTON SECRETARY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TERRI WOODWARD
PRESIDENT
145 GLADEFIELD DRIVE
LA FOLLETTE TN 37766

Officer/Director/Trustee Two

MICHELLE DAVIS
VICE PRESIDENT
238 SKYVIEW LANE
LAFOLLETTE TN 37766

Officer/Director/Trustee Three

DEBORAH PEMBERTON
SECRETARY/TREASURER
231 LAKEHSORE LANE
LA FOLLETTE TN 37766

Organization’s website SPAYCCTNPETS.COM
Organization’s email SPAYCCPETS@GMAIL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2016
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: 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 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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