FORM 1023-EZ for PETTIBONE FAMILY MINISTRIES INC

Field Data
EIN 84-4128597
Case Number EO-2020031-000141
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PETTIBONE FAMILY MINISTRIES INC
Organization’s Mailing Address 78 ROBERTA DRIVE
City MIDDLETOWN
State CT
ZIP 06457
Accounting period End 12
Primary contact name RONALD PETTIBONE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RONALD PETTIBONE
PRESIDENT
78 ROBERTA DRIVE
MIDDLETOWN CT 06457-5510

Officer/Director/Trustee Two

AMBRA PETTIBONE
VICE PRESIDENT
78 ROBERTA DRIVE
MIDDLETOWN CT 06457-5510

Officer/Director/Trustee Three

GEEN THAZHAMPALLATH
SECRATARY
71 RIBERA LANE
MIDDLETOWN CT 06457-5510

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/26/2019
Organization Incorporation State CT
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name RONALD PETTIBONE
Signature Title PRESIDENT
Signature Date 1/29/2020

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