FORM 1023-EZ for AKITA CLUB OF AMERICA RESCUE

Field Data
EIN 82-2741121
Case Number EO-2017256-000255
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AKITA CLUB OF AMERICA RESCUE
Organization’s Mailing Address 23 GRANDVIEW DRIVE
City POESTENKILL
State NY
ZIP 12140
Accounting period End 12
Primary contact name WAYNE BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WAYNE BROWN
PRESIDENT
23 GRANDVIEW DRIVE
POESTENKILL NY 12140

Officer/Director/Trustee Two

ANN BAVARIA
VICE PRESIDENT
1421 GREENE HILL CT
KUTZTOWN PA 19530

Officer/Director/Trustee Three

SHERRY LOCKREM
CHIEF FINANCIAL OFFICER
4309 DILORETO AVW
MADISON WI 53704

Officer/Director/Trustee Four

SHELLEY PRYOR
CORRESPONDING SECRETARY
6345 WESTMINSTER PLACE
UNIVERSITY CITY MO 63130

Officer/Director/Trustee Five

JO ANN DIMON
RECORDING SECRETARY
2611 4TH AVE
TOMS RIVER NJ 08753

Organization’s website WWW.AKITACLUBRESCUEFUND.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/5/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D12 - Fund Raising and/or Fund Distribution
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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