FORM 1023-EZ for UINTA COUNTY SUICIDE PREVENTION TASK FORCE

Field Data
EIN 81-3628810
Case Number EO-2016251-000241
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name UINTA COUNTY SUICIDE PREVENTION TASK FORCE
Organization’s Mailing Address PO BOX 1757
City EVANSTON
State WY
ZIP 82931-1757
Accounting period End 12
Primary contact name KIMBERLY LAHM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KIMBERLY LAHM
CHAIR
228 CHEYENNE DR
EVANSTON WY 82930-4550

Officer/Director/Trustee Two

MARY HIPOL
CO-CHAIR
1632 CENTER STREET
EVANSTON WY 82930-3129

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 WY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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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