FORM 1023-EZ for LAFAYETTE COUNTY EMS

Field Data
EIN 20-2170456
Case Number EO-2016208-000200
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAFAYETTE COUNTY EMS
Organization’s Mailing Address P O BOX 2614
City OXFORD
State MS
ZIP 38655-2614
Accounting period End 12
Primary contact name JAMES T COX ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BOBBY MCCAIN
PRESIDENT
41 COUNTY ROAD 373
WATER VALLEY MS 38965

Officer/Director/Trustee Two

FELECIA ARENDALE
VICE-PRESIDENT
16 COUNTY ROAD 541
COMO MS 38965

Officer/Director/Trustee Three

SIDNEY MCCAIN
SECRETARY
41 COUNTY ROAD 373
WATER VALLEY MS 38965

Officer/Director/Trustee Four

FELECIA ARENDALE
TREASURER
16 COUNTY ROAD 541
OXFORD MS 38655

Officer/Director/Trustee Five

CHRISTOPHER ELLIS
DIRECTOR
2400 ANDERSON ROAD NO 23
OXFORD MS 38655

Organization’s website
Organization’s email JCOX@COXLAWGRP.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/2004
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M23 - Search and Rescue Squads, 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
Signature Title
Signature Date

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