FORM 1023-EZ for PELLSTON AREA FOOD PANTRY

Field Data
EIN 47-3741320
Case Number EO-2015295-000401
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PELLSTON AREA FOOD PANTRY
Organization’s Mailing Address PO BOX 467
City PELLSTON
State MI
ZIP 49769
Accounting period End 12
Primary contact name STEFAN J SCHOLL ATTORNEY AT LAW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RANDOLPH BRICKER SR
PRESIDENT/DIRECTOR
PO BOX 467
PELLSTON MI 49769

Officer/Director/Trustee Two

MICHAEL BOHN
DIRECTOR
6688 W LEVERING RD
LEVERING MI 49755

Officer/Director/Trustee Three

JUNE BOHN
TREASURER/DIRECTOR
6688 W LEVERING RD
LEVERING MI 49755

Officer/Director/Trustee Four

MARY HESSEL
DIRECTOR
6869 LAHTI LANE
PELLSTON MI 49769

Officer/Director/Trustee Five

JANE ANN ROSE
SECRETARY/DIRECTOR
6076 STATE ST
PELLSTON MI 49769

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/17/2015
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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
Signature Title
Signature Date

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