FORM 1023-EZ for TRI-STATE ALLIANCE FOR FAMILIES ANDENVIRONMENT INC

Field Data
EIN 47-2847260
Case Number EO-2015120-000248
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TRI-STATE ALLIANCE FOR FAMILIES ANDENVIRONMENT INC
Organization’s Mailing Address PO BOX 81
City GALENA
State KS
ZIP 66739-0081
Accounting period End 12
Primary contact name BRYANT BURNETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JIM BURTON
CHAIRMAN
300 EAST MAPLE
COLUMBUS KS 66725

Officer/Director/Trustee Two

BRANDON WILLIAMS
VICE CHAIRMAN
PO BOX 660
BAXTER SPRINGS KS 66713-0660

Officer/Director/Trustee Three

LLOYD HANCOCK
TREASURER
1150 W 5TH STREET
BAXTER SPRINGS KS 66713

Officer/Director/Trustee Four

DEBBIE DOTSON
SECRETARY
10800 S BLUEJACKET ROAD
WYANDOTTE OK 74370

Officer/Director/Trustee Five

BRYANT BURNETT
DIRECTOR
PO BOX 81
GALENA KS 66739-0081

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/12/2014
Organization Incorporation State KS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
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 Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
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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