FORM 1023-EZ for LIGHTSHINE CANINE - A REZ DOG RESCUE

Field Data
EIN 47-3048896
Case Number EO-2015175-000274
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIGHTSHINE CANINE - A REZ DOG RESCUE
Organization’s Mailing Address 1341 SOUTH BOWEN ST
City LONGMONT
State CO
ZIP 80501-6646
Accounting period End 12
Primary contact name PAMLEA BETH NICHOLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PAMELA NICHOLS
PRESIDENT
1341 SOUTH BOWEN ST
LONGMONT CO 80501-6646

Officer/Director/Trustee Two

AMY SIMMS
VICE PRESIDENT
1721 PARKDALE CIRCLE SOUTH
ERIE CO 80516-2408

Officer/Director/Trustee Three

DENISE ANDERMAN
SECRETARY/TREASURER
5800 BAKER ROAD STE 110
MINNETONKA MN 55345-5979

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2015
Organization Incorporation State CO
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: Yes
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 Yes
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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