FORM 1023-EZ for BLUE RIVER PET RESCUE

Field Data
EIN 27-4788398
Case Number EO-2014281-000307
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLUE RIVER PET RESCUE
Organization’s Mailing Address 1040 SOUTH ST
City SEWARD
State NE
ZIP 68434-2341
Accounting period End 12
Primary contact name DAN ELLIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DANIEL ELLIS
PRESIDENT
1187 AUGUSTA DR
SEWARD NE 68434

Officer/Director/Trustee Two

RONALD WALLMAN
VICE-PRESIDENT
2574 WAVERLY RD
SEWARD NE 68434

Officer/Director/Trustee Three

TERRI SIEBERT
TREASURER
1356 182ND RD
SEWARD NE 68434

Officer/Director/Trustee Four

LINDA MOLTHAN
SECRETARY
600 SEWARD ST
SEWARD NE 68434

Officer/Director/Trustee Five

DONNA HAVENER
DIRECTOR
720 6TH ST
MILFORD NE 68405

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/4/2011
Organization Incorporation State NE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
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 Yes
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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