FORM 1023-EZ for FRIENDS OF THE CAMERON ANIMAL SHELTER

Field Data
EIN 84-1964293
Case Number EO-2019169-000565
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FRIENDS OF THE CAMERON ANIMAL SHELTER
Organization’s Mailing Address 312 N WALNUT ST
City CAMERON
State MO
ZIP 64429-1844
Accounting period End 12
Primary contact name MARK CARR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARK CARR
PRESIDENT
312 NORTH WALNUT STREET
CAMERON MO 64429-1844

Officer/Director/Trustee Two

LANA SUE MANION
VICE PRESIDENT
602 LANA DRIVE SUITE C2
CAMERON MO 64429

Officer/Director/Trustee Three

NADA WOODWORTH
SECRETERY
10485 NORTHWEST OREGON DRIVE
CAMERON MO 64429

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/17
Organization Incorporation State MO
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARK CARR
Signature Title PRESIDENT
Signature Date 6/15/19

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