FORM 1023-EZ for VAN BUREN ANIMAL SHELTER

Field Data
EIN 83-2334222
Case Number EO-2019028-000274
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name VAN BUREN ANIMAL SHELTER
Organization’s Mailing Address PO BOX 122
City SPENCER
State TN
ZIP 38585
Accounting period End 10
Primary contact name MARY ANN DODSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY ANN DODSON
PRESIDENT, DIRECTOR
PO BOX 122
SPENCER TN 38585

Officer/Director/Trustee Two

MYRIAM APONTE
SECRETARY, DIRECTOR
PO BOX 122
SPENCER TN 38585

Officer/Director/Trustee Three

CARLIE LEFEBVRE
TREASURER, DIRECTOR
PO BOX 122
SPENCER TN 38585

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/10/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D60 - Other Services - Specialty Animals
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 MARY ANN DODSON
Signature Title PRESIDENT, DIRECTOR
Signature Date 12/14/18

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