FORM 1023-EZ for LILLIE BIRDS WILDLIFE REHABILITATION

Field Data
EIN 82-4383281
Case Number EO-2018095-000487
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LILLIE BIRDS WILDLIFE REHABILITATION
Organization’s Mailing Address 2829 BARCLAY DRIVE
City NASHVILLE
State TN
ZIP 37206
Accounting period End 12
Primary contact name DEVON BLACKBURN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEVON BLACKBURN
DIRECTOR
2829 BARCLAY DR
NASHVILLE TN 37206-1511

Officer/Director/Trustee Two

JASON BLACKBURN
DIRECTOR
2829 BARCLAY DR
NASHVILLE TN 37206-1511

Officer/Director/Trustee Three

DEVON CANNON
DIRECTOR
400 BELLE VALLEY DR
NASVILLE TN 37209-5129

Organization’s website
Organization’s email LILLIEBIRDSWILDLIFE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/17/16
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D34 - Wildlife Sanctuary, Refuge
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 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 DEVON BLACKBURN
Signature Title DIRECTOR
Signature Date 3/21/18

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