FORM 1023-EZ for NORTHWEST FLORIDA PRESCRIBED BURN ASSOCIATION INC

Field Data
EIN 87-2074578
Case Number EO-2021223-000375
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHWEST FLORIDA PRESCRIBED BURN ASSOCIATION INC
Organization’s Mailing Address 619 BROOKHAVEN WAY
City NICEVILLE
State FL
ZIP 32578-4044
Accounting period End 12
Primary contact name GARY JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GARY JOHNSON
PRESIDENT
619 BROOKHAVEN WAY
NICEVILLE FL 32578-4044

Officer/Director/Trustee Two

PAUL HURST
VICE PRESIDENT
2851 ROYAL PALM WAY
TALLAHASSEE FL 32309

Officer/Director/Trustee Three

STEPHANIE HUDSON
SECRETARY
3350 HIGHWAY 4A
CENTURY FL 32535

Officer/Director/Trustee Four

EASTON WALTER
TREASURER
2045 CEYLON ROAD
PENSACOLA FL 32526

Officer/Director/Trustee Five

KEITH YOCKEY
BOARD MEMBER
4021 BOND CIRCLE
NICEVILLE FL 32578

Organization’s website
Organization’s email NWFPBAINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/9/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C34 - Land Resources Conservation
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name GARY JOHNSON
Signature Title PRESIDENT
Signature Date 8/9/2021

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