FORM 1023-EZ for RUSTBURG ELEMENTARY PARENT TEACHERORGANIZATION

Field	Data
EIN	83-4249913
Case Number	EO-2019158-000213
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	RUSTBURG ELEMENTARY PARENT TEACHERORGANIZATION
Organization’s Mailing Address	25 WEBBS WAY
City	RUSTBURG
State	VA
ZIP	24588
Accounting period End	5
Primary contact name	ERIKA CHEATHAM
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00

Officer/Director/Trustee One

ASHLEY WITT-GAITHER
PRESIDENT
432 PAULS RD
RUSTBURG VA 24588

Officer/Director/Trustee Two

ROBIN ELLIOTT
SCHOOL LIAISON
325 BROOKWOOD DRIVE
LYNCHBURG VA 24501

Officer/Director/Trustee Three

CHARLES B IV MILLER
VICE PRESIDENT
51 SUMMERDALE LN
EVINGTON VA 24550

Officer/Director/Trustee Four

JAMIE MILLER
SECRETARY
51 SUMMERDALE LN
EVINGTON VA 24550

Officer/Director/Trustee Five

ERIKA CHEATHAM
TREASURER
3484 RED HOUSE RD
RUSTBURG VA 24588

Organization’s website	HTTPS://WWW.FACEBOOK.COM/GROUPS/1392068861033951/
Organization’s email	RUSTBURGELEMENTARYPTO@GMAIL.COM
Organization Incorporated	No
Organization trust	No
Necessary Organizing Documents	Yes
Organization Incorporation Date	5/9/19
Organization Incorporation State	VA
Contains Limitation	Yes
Does not expressly empower	Yes
Contains dissolution	Yes
National Taxonomy of Exempt Entities (NTEE) code	B94 - Parent/Teacher Group
Organization’s purpose	Charitable: Yes 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	No
One Third Support Gifts	No
Benefit of College	No
Private Foundation 508(e)	Yes
Seeking Retroactive Reinstatement	No
Seeking Section 7 Reinstatement	No
Correctness Declaration	Yes
Signature Name	ERIKA CHEATHAM
Signature Title	TREASURER
Signature Date	6/5/19
EIN	83-4249913
Case Number	EO-2019158-000213
Form 1023-EZ version	12018
Eligibility Worksheet	1
Organization Name	RUSTBURG ELEMENTARY PARENT TEACHER ORGANIZATION
Organization’s Mailing Address	25 WEBBS WAY
City	RUSTBURG
State	VA
ZIP	24588
Accounting period End	5
Primary contact name	ERIKA CHEATHAM
Primary contact phone	[Hidden]
Primary contact phone extension	[Hidden]
Primary contact fax	[Hidden]
User fee submitted	$275.00