FORM 1023-EZ for SSG KEN VANGIESEN MEMORIAL FALLEN SOLDIER TRIBUTE INC

Field Data
EIN 45-3995015
Case Number EO-2015075-000381
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SSG KEN VANGIESEN MEMORIAL FALLEN SOLDIER TRIBUTE INC
Organization’s Mailing Address 35 OLD MILL RD
City KANE
State PA
ZIP 16735
Accounting period End 12
Primary contact name JAMES EMBREY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

AMIE GULLIFER
PRESIDENT
35 OLD MILL RD
KANE PA 16735

Officer/Director/Trustee Two

JOHN BERNHARD
VICE-PRESIDENT
24 OBERG AVE
MT JEWETT PA 16740

Officer/Director/Trustee Three

SUSAN VANGIESEN
TREASURER
137 LINCOLN STREET
KANE PA 16735

Officer/Director/Trustee Four

RENEE MCKAY
SECRETARY
PO BOX 387
LEWIS RUN PA 16738

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/30/2011
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Z99 - Unclassified
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 No
Donation of funds Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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