FORM 1023-EZ for ADAMS CEMETERY ASSOCIATION INC

Field Data
EIN 85-3952171
Case Number EO-2021263-000795
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ADAMS CEMETERY ASSOCIATION INC
Organization’s Mailing Address PO BOX 209
City MOLALLA
State OR
ZIP 97038
Accounting period End 12
Primary contact name RICK DISHNER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT OBLACK
PRESIDENT
PO BOX 1170
MOLALLA OR 97038

Officer/Director/Trustee Two

LORA RITCHIE
SECRETARY
PO BOX 724
MOLALLA OR 97038

Officer/Director/Trustee Three

RICK DISHNER
TREASURER
PO BOX 817
MOLALLA OR 97038-0817

Officer/Director/Trustee Four

ROBERT WENZ
DIRECTOR
PO BOX 1244
MOLALLA OR 97038

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/2/1962
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y50 - Cemeteries, Burial Services
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 No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name RICK DISHNER
Signature Title TREASURER
Signature Date 9/18/2021

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