FORM 1023-EZ for LAKE CAREY DAM ASSOCIATION

Field Data
EIN 84-2366176
Case Number EO-2019217-000213
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LAKE CAREY DAM ASSOCIATION
Organization’s Mailing Address PO BOX 637
City TUNKHANNOCK
State PA
ZIP 18657
Accounting period End 12
Primary contact name EDWARD HETZEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EDWARD HETZEL
PRESIDENT
38 MARINA
TUNKHANNOCK PA 18657

Officer/Director/Trustee Two

DAVID RINEHIMER
VICE PRES
32 SHORE DR
TUNKHANNOCK PA 18657

Officer/Director/Trustee Three

DEBRA TIERNEY
TREASURER
11 UNION CHAPEL DR
TUNKHANNOCK PA 18657

Officer/Director/Trustee Four

WALTER BROUGHTON
SECRETARY
526 ORLANDO AVE
STATE COLLEGE PA 18657

Officer/Director/Trustee Five

PETER BUTLER
DIRECTOR
20 ANDERSON ACRES
TUNKHANNOCK PA 18657

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/19
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S22 - Neighborhood, Block Associations
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 DEBRA TIERNEY
Signature Title TREASURER
Signature Date 8/1/19

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