FORM 1023-EZ for MINERAL-GOLD VOLUNTEER FIRE AND RESCUE DEPARTMENT

Field Data
EIN 85-2793695
Case Number EO-2021064-000655
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MINERAL-GOLD VOLUNTEER FIRE AND RESCUE DEPARTMENT
Organization’s Mailing Address 111 EAST MAIN STREET
City MINERAL
State IL
ZIP 61344
Accounting period End 12
Primary contact name JON BLACKERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JON BLACKERT
PRESIDENT/DIRECTOR
22515 150 EAST STREET
MINERAL IL 61344

Officer/Director/Trustee Two

JENNIFER BLACKERT
DIRECTOR
22515 150 EAST STREET
MINERAL IL 61344

Officer/Director/Trustee Three

ROSEMARY GOOSSENS
DIRECTOR
23713 150 EAST STREET
SHEFFIELD IL 61361

Officer/Director/Trustee Four

WARD BLACKERT
VICE PRESIDENT/DIRECTOR
20816 150 EAST STREET
MINERAL IL 61344

Officer/Director/Trustee Five

VICKY RAMBO
SECRETARY/TREASURER
20816 150 EAST STREET
MINERAL IL 61344

Organization’s website NONE
Organization’s email MINERAL_FIRE@MEDIACOMBB.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/17/2020
Organization Incorporation State IL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M24 - Fire Prevention, Protection, Control
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: Yes
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 Yes
Disaster relief assistance Yes
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JON BLACKERT
Signature Title PRESIDENT/DIRECTOR
Signature Date 1/5/2021

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