FORM 1023-EZ for AVOCA FOOD PANTRY

Field Data
EIN 81-3925775
Case Number EO-2020170-000204
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AVOCA FOOD PANTRY
Organization’s Mailing Address PO BOX 177
City AVOCA
State IA
ZIP 51521
Accounting period End 12
Primary contact name NAN SAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NAN SAMS
PRESIDENT
713 N CHESTNUT ST
AVOCA IA 51521

Officer/Director/Trustee Two

DIANE JACOBSEN
SECRETARY
314 E JAYCEE ST
AVOCA IA 51521

Officer/Director/Trustee Three

BETTY MORRIS
DIRECTOR
PO BOX 103
AVOCA IA 51521

Officer/Director/Trustee Four

RONDA HOLTZ
DIRECTOR
416 W MARQUARDT ST
AVOCA IA 51521

Officer/Director/Trustee Five

CAROLYN PIITTMANN
DIRECTOR
1106 N POPLAR ST
AVOCA IA 51521

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/29/2016
Organization Incorporation State IA
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name NAN SAMS
Signature Title PRESIDENT
Signature Date 4/3/2020
EIN 81-3925775
Case Number EO-2016274-000228
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AVOCA FOOD PANTRY
Organization’s Mailing Address 1512 N WILLOW ST
City AVOCA
State IA
ZIP 51521
Accounting period End 12
Primary contact name DOROTHY L NELSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERTA GILLETTE
PRESIDENT
1512 N WILLOW
AVOCA IA 51521

Officer/Director/Trustee Two

NAN SAMS
OFFICER/TRUSTEE
713 N CHESTNUT ST
AVOCA IA 51521

Officer/Director/Trustee Three

PAT WIEGAND
OFFICER/TRUSTEE
215 E THOMAS
AVOCA IA 51521

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/2016
Organization Incorporation State IA
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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