FORM 1023-EZ for PUTNAM COUNTY SHERIFFS OFFICE PAL INC

Field Data
EIN 36-4744534
Case Number EO-2014240-000537
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PUTNAM COUNTY SHERIFFS OFFICE PAL INC
Organization’s Mailing Address 130 ORIE GRIFFIN ROAD
City PALATKA
State FL
ZIP 32177
Accounting period End 9
Primary contact name LORI MILAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JEFF HARDY
PRESIDENT
130 ORIE GRIFFIN ROAD
PALATKA FL 32177

Officer/Director/Trustee Two

LORI MILAM
TREASURER
358 CEDAR CREEK ROAD
PALATKA FL 32177

Officer/Director/Trustee Three

BARRY STEWART
EXECUTIVE DIRECTOR
113 PUTNAM COUNTY BLVD
EAST PALATKA FL 32131

Officer/Director/Trustee Four

DOMINICK PISCITELLO
VICE PRESIDENT
130 ORIE GRIFFIN ROAD
PALATKA FL 32177

Officer/Director/Trustee Five

MICHELLE GARNER
SECRETARY
105 SUNSET LANE
PALATKA FL 32177

Organization’s website
Organization’s email ANTICRIMETASKTEAM@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/16/2012
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O51 - Youth Community Service Clubs
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 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
Signature Title
Signature Date

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