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2007 Enfield Volunteer Fire Company documents
February 23, 2007 Alice Laue Enfield Town Clerk 168 Enfield Main Road Ithaca, NY 14850 Alice could you please distribute this to all: Town Board members, it was missing Rom the ly ort given to the Also,st it is my that you have our February check which Y � Y they are holding until February 28th. If possible could you drop it in the mail so we receive it no later than March 1 St Thanks, Dennis G. Hubbell President Enfield Volunteer Fire Company Inc, dghubbell@htva.net Quarterly Report 1/1/2006 Through 12/31/2006 2/22/2007 Page 1 1/1/2006- 10/1/2006 - Category Description 12/31/2006 12/31/2006 INCOME Income 240,769.00 0.00 TOTAL INCOME 240,769.00 0.00 EXPENSES Admin -OSHA 797.98 52.99 Admin -Reimburse ` 3,575.26 852.14 Administration 9,874.85 7,471.40 Building -Ground 6,694.44 860.40 Fire Equipment 9,205.16 1,878.80 Hlth&Safety 12,580.98 10,360.81 Insurance 36,362.65 3,881.00 Loans 107,862.27 10;392.60 Operations 3,687.02 3,108.12 Rescue 1,634.99 667.15 Training 1,154.27 295.00 Truck Maint 10,391.12 1,141.36 Utilities 19,117.33 5,924.04 TOTAL EXPENSES 222,938.32 46,885.81 OVERALL TOTAL 17,830.68 -46,885.81 Incorporated 1948 January 2007 call list Jan. 31, 2007: 05:20 PM Vehicle accident, Black Oak & Connecticut Hill Rd Jan. 28, 2007: 10:01 PM Emergency medical call Jan. 25, 2007: 06:23 AM Vehicle accident with no injuries on Mecklenburg Rd Jan. 23, 2007: 07:13 PM Fire alarm Enfield School, accidental activation Jan. 23, 2007: 11:04 AM Smoke condition in a residence on North Applegate Jan. 22, 2007: 01:07 PM Vehicle fire on Bostwick Rd. Fire confined to the dash Jan. 22, 2007: 07:09 AM Mutual aid to Mecklenburg for a carbon monoxide Jan. 211, 2007: 10:54 PM Vehicle accident with injuries on Iradell Rd. Jan. 21,,2007: 05:30 PM Residential fire alarm, no fire, ,caused by dust Jan. 20, 2007: 09:12 PM Emergency medical call Jan. 20, 2007: 08:46 PM Vehicle accident with injuries on Trumbulls Corner Rd Jan. 19, 2007: 09:56 AM Emergency medical call Jan. 18,2007: 03:20 PM Emergency medical call Jan. 14, 2007: 01:47 AM Emergency medical call Jan. 1292007: 11:45 PM Emergency medical call Jan. 07, 2007: 09:22 PM Vehicle accident on Black Oak with no injuries Jan. 07, 2007: 09:20 PM Emergency medical call Jan. 07, 2007: 08:51 PM Emergency medical call Jan. 07, 2007: 08:38 PM Emergency medical call Jan. 0692007: 06:53 AM Emergency medical call Jan. 06, 2007: 05:14 AM Emergency medical call Jan. 04, 2007: 09:19 AM Grass fire at Mecklenburg Rd. and N.Van Dorn Rd. Jan. 03, 2007: 11:55 PM Emergency medical call Jan. 01, 2007: 12:58 AM Emergency medical call APRIL f S'PH RIGHT TD KNo w, HAZ-COM, HAZ-MAT RESPONSE PLAN MANDATORY OSHA 22ND SCBA DONNING, MAINTENANCE DRILL 19:30 HRS 29TH SCBA SEARCH AND RESCUE DRILL 19:30 12TH AUTO EXTRICATION PART 1 19:30HRS 19TH AUTO EXTRICATION PART II 19:30 HRS 26TH STATION MAINTENANCE DR/LL 1930 622x621 DETAIL OMS No 1546bG67 Form 990 Retum of Organization Exempt from Income Tax Under section 501(c), 5Z7, or 4947(a)(1) of the Intemaf Revenue Code 2004 f Depnrtmmrt d dm Tremury (except black lung benefit trust or private foundation) - .. to Public . a,o.md R.venus service ► The organization may have to use a of this return to satisfy siy state reporting tt�gl�irlpnnents.: �ihspectlon-:... A For the 2004 calendar year, or tax year bealnrdng 2004, and ending 8 :Matt if appombie C Name or orparmuo" D E- -- .Irplgra►NientKlotl=n NumberMeow Los i. AiMmdrerge iRs ww Enfield Fire Department 16-1334367 . Nemo change wqp. Numbaramw..t(OtPO b6sr,>m knctdetNra.em.eraetadd4 iooMaft E Tdoomm ausaw - Inkalreturn ep-;Kc 172 Enfield,Ma.inr.St... - (607).:272-8757 Irsa..o- i Final rutum dors. CIY. u=Tn or country - .S MlpMdas4F rine L]C.* ®AocnW i naraneed reb,m Ithaca MY : 14850 n other (,PeeA).I- ;.. . ]"icaft P"hg eSection 501(c)(3)organizations and 4947((a��(1) nonexempt . Hand Iaveaoteppdeab/etosection 527ap.atMislaa- - - charitable trusts must attach a complated Sc adute A (Form 990 or 990•x. 14 (a) is nus a group =turn for amnetaA rw Ne G Web site: ► N/A H (b) KYes, enternunmercrambaras.. H (c) Are as rn Mft Ind Wed7 . .. Q rw El No J Orga nitdtlorw i type lu No oar a 1kL sea l (check only one) ► 501 (C) 3 _Onseana) ❑ 4947tax1)or S2r K Check here ► If the organization's gross receipts are normally not more than (d) i""a a sepe.a.e.eban lbea by an ^ 1 4 525,000 The organization need not fie a return with the IRS, but if the organization organs tOYamd by a group °i1°'ai M C received a Form 990 Package in the mail, it should file a return without financial data. i Group Exemption t+lunber . - ].1i/A Some states require a complete return. tL^,J1 j acct - If lite crIantta"" a tasC tetµtred; L GrpsS rfpeI is Add lines 6b, 8b, 9b, and 10b to line 12.. ► 286, 253. toatlach&tierf*00:attn990.9aq.El,br99aP ). P. t s,l i#evenue, Expenses, and Changes in Net Assets or Fund Sa(aiees lyes Instructions) 1 Contributions, gids, grants, and similar amounts received a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a 11, 873. b Indirect public support . . . . . . . . . . . .... . . .... _ . . . . . 1 b c Government contributions (grants) ............... .. 1 C 441249- em ones - - . d Tr>dl /I ) t f . 1 d i a thrdrpb is �asn $ . ...r>� 2 Program service revenue including government fees and contracts (from Part VII, line 93) 3 Membership dues and assessments .. .. .... ...... .............. .. 153 4 Interest on savings and temporary cash investrnents ............. ... 4.1 5 Dividends and Interest from securities . . . . . . . . .... .. . ... .. . .. . . . . 6a Gross rents . .. .. . .. . . . . . . . ..... ....... .... .. Gal bLess rental expenses . ... .. ... . . . .. . ........ .. , tib c Net rental income or (loss) (subtract line 6b from line 6a) , .... ... .... . .. 8c . R 7 Other investment income (describe . . . . . , ► • . . •) 7. i t Seddies v 8 a Gross amount from sales of assets other (A)cu ($) 011ier N than Inventory . ... . .. . . . ... .. ..... _si 200 i E b Less cost or other basis and safes expenses....... ab ; c Gain or (foss) (attach sctredule) .. .. 8 c 200. d Net gain or (loss) (combine Pure ac, columns (A) and (B)) ........ . .... . ........ .. ... ad 200 9 Special events and activities (attach schedule) If any amount is from gaming, check here . . , ► C= a Gross revenue (not including $ of contributions 0 �+ reported on line 1a) . ............ ... ........ ... . �: go 6_939. I co �b Less direct expenses other than fundralstog expenses . ... . . . .. 5,586 r f c Net income or (loss) from special events (subtract line 9b from line 96) . ... ... .. ... ' 8c 1,353. W10a Gross sales of inventory, less returns and allowances 0 b Less- cost of goods sold . . . . . . . . . , lob Q c Gross profs or (loss) from sales of mvw" (attach SChedule) (Subtract lots 10b fro11 b* 1.a) ........ .. 10e u1 11 Other revenue (from Part Vil, line 103) :. .' . � 411 i 12 Totalrevanue(addlinesld,2,3,4,5,61,7,-Bd9e; {� •it2 .280,667. Z e 13 Program services (from line 44. column (B)) .... ... wL+ U 13 .260, 053. U x 14 Management and general (from line 44, column (q) ! AQV ,Z (4 36, 094- 2095* 94 _ 1" 249 E 15 Fundraising (from line 44, column (D)) . , ... .. 1S 6,379. f (!� �. s 18 Payments to affiliates (attach schedule) ... �.�1 .�„ . . Jr . . . 16 s 17 Total expenses (add lines 16 arta 44, coturnn;(Ap ! +,� fi_`. V302,526_ A 18 Excess or (deficit) for the year (subbed brie 17frtim ikte i2) �Jy -21,859. N as 19 Net assets or fund balances at beginning of year (from file 73, column (A)).....Y +, 78. 171,969- E 71,969- T T 20 Other changes in net assets or fund balances (affach explanaton) . . . , ... s 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) . . _ 21 1,50,110 BAA For Privacy Act and Paperwork Reduction Act Notate, see the separate kwitructions. TEEA0101 0mim Fortis 000 (2604) 17 Form 980(20D4) Enfield Fire- Dqpartment 16-1334367 Paget' ` IPart'll': I Statement of Functional Ex uses All organizations must complete column (A) Columna (B), (C), and (D) are for 501(c)(3) required section and (4) organizations and section 4547(a)(f) nonexempt charitable trusts but optional for others. Do not include amounts reported on Erre t31 program (A) Total ( (Cand 6b, 8b, 9b, iQb, or 16 0l Part t. services general (D) Fuutdrasing 22 Grants and allocations (alt sch) - '� ' " (cash $ 550. non-cash $ ). 22 550, 550. ? 23 Speafx asscsLtrxe to mdmduais (an sch) 0 0 • ' •f 24 Benefits paid to or for members (an sch) . . . 4 j a- 0. y 25 Cam on of officers, derectors, etc 25 0 , 91 0. 2Other plans 27 Pension contributions . . . . ... . 27 i D 28 Other employee benefits . . . ..... 28 0.1 .. 00. 0. 29 Payroll taxes . . . . . . . . . . . . . . . 29 0 1 D 30 Professional fundraising fees . . . . . . . 30 6,179: j fl... 0.; 64 379, . 31 Accounting fees . . . . . . . . . . . . . 31 400. 0.i 400:1 0,, 32 Legal fees . . . . . . . . . . . . . . . . 32 145. 145 . 01: 0.. 33 Supplies . . . . . . . . . . . . . . . . . 33 9, 7$5: `.. 8 7$5. _ fl ._ 0_- 34 Telephone . . 34 1, 709, 35 Postage and shipping. . . . . . . . . . . 35 3S3. 0,. 38 Occupancy.. ...... ........I 38 22,401,. _ '9.317. 13.084. (: 0,.. 37 Equipment rental and maintenance. , . 1 37 91715. 9, 715 0. .0. 38 Printing and publications . ..:.. , 38 0. 0.. . 39 Travel . . . . . . . . . . .. ...... 39 0 0.1 0. 0 40 Conferences, omweribm, and meetings.... 40 0 : .... 0. _ _ 0 :. 0 41 Interest... .............. . 41, 16,130,.1 15,130. D: 0. 42 Depreciation, depielon, etc (attach sched0e) - . 43 137, 411.: il18, 588. 18,823. 6. 43 Other exMtses not covered above (nerruze): a Administrative 43a ------ ------------ 787.111 0, 7.87.. ..: D. . --- bMiscellaneoua ______ 43bl 53-,063. 53,063. c_F_ue_1434I',037. 1,037, D:;. 0, d Rescue & Training 43d 1,816111:,816. o See Other Ex ses Stmt _ fie"_ 43e 41-, 845 . j : 3t3. 845. 3.,000: 0 44 Tara) hRlcdotsal (add Imes ?2 - 43 . �tatats�13-15 . 44 302, 526 .2..60._053 , 36, 094. 6,379. Joint Costs. Check ► U if you are following SOP 98-2` ' Are any joint costs from a combined educational campaign and iundr> z hg soliciWon teported in (B) ProcjammVices? ... .... Yes No. if 'Yes,' enter (1) the aggregate amount of these joint costs; $ . . (11) the amount allocated to Program servicers $ , (111) the amount allocated to Management and general $ 2nd (W) the amount allocated to Fundraising $ Part D( - A Statement of Program Service Accomplishments What is the organization's primary exempt purpose? ► Provide Communit mire � Saft Services p►rSetvice Ertses yy _ fasohtE )e a a deararxTconc�se All organaations must describe their exempt purpose achtev&r enifs'Tn marmer1ftatelie numbC . clients served, publications issued, etc f3iscuss achievements that are not measurable (Section 501(ce}( & (4) ot�an- a>�a7 axu l win W izations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants & allocations fo others,) oyuawror ahw&) a _C_ommunity Fire Department provides over 13, OOO persc3rinel hours suppor>_ing xepsonses for fire. _rescue,_EMS�and other services" !.--- -----------------------------_---------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ----------- (Grants and allocations $ 0.1 141, 4155. b ------------------------------------------------------ (Grants and allocations $ ) c ------------------------------------------------ --- -- (Grants and allocations $ ) d------------------------------------ - - - - - - - - - - - - - - - - ------------------------------__---------------------- (Gr& is and atncatinne e Other program services. . . .. (Grants and allocasOns -$ f Total of tram Service Expanses (should equal line 44. ootumn (6),_Program services) .. .......... . •r 141_. 465 SAA TEEnotoz 0110705 poem W (2604) > .. Form 990 (2004) Sn f i e l d Fire Department IParfW,,'- �-j Balance Sheets (see Instructions) 16-.1334367 PefjA3 Note. Where required, attached schedules and amounts within the description (A) (g) column should be for end -of --year amounts only. of year . End of year -> 45 Cash — non4nterest-beanng . . . . . . . . . .. ... . . . . . . . . . . . .. 66,235-145 28, .601._ .' 46 Savings and temporary cash investments . ... ... .. . . . - 46 47 a Accounts receivabie . . . . . . . . . . . . . . . . . 47a b Less allowance for doubtful accounts . . . . . . . . 47b I ,- 47c 48a Pledges receivable . 48a b Less allowance for doubtful amounts . . . . . . . . 48b �e 49 Grants receivable . . .. . .. ... . .......... . . tt 1� A 50 Receivables from officers, directors, trustees, and key s employees (attach schedule) ... . ......... .. ... 30 E51 a Other roles &loans receivable (attach sch) . . . . ... . 31 a T b Less allowance for doubtful accounts ........ 51 bI sic 52 Inventones for sale or use . . . . . . . ..... .... . . .. . 53 Prepaid expenses and deterred charges ...... ' Sg 54 Investments — securities (attach schedule) :...:. ... IOU, Cost FMV 94 55a Investments — land, buildings, & equipment basis .. 35i1 . b Less accumulated depreciation (attach schedule) . . . . . . . . . . . . . ... ,: • •. S_Sbe .. 56 Investments — other (attach schedule) .. ... 57a Land, buildings, and equipment basis . . . . , . . 578 .. 2;,010,, 3.68 b Less accumulated depredation (attach schedule) . . . . . . . . . . . . . . .. . . 57b 1, 23.4.410-. - S05."249. 67e 58 Other assets (describe • r . 59 Tata) assets (add lines 45 through 58) (must e4ual line I 60 Amounts payable and accrued expenses...... ... 400.• 1 j.0 80'0._ L 61 Grants payable . . . . . . . . . . . . . . . .. . . .... .. .,. . .. . .. .. ¢1 A 62 Deferred revenue .. .. .. ........... 02 63 Loafrom officers, detectors, 0ustees, and key employees (am ach schedule) .. , 83 L' 64a Tax-exempt bond liabilities (attach schedule).. .. ; . .... .. 64a1 b tliarfgages and other rotes payable (attath9Chedule) .. . .. ...... .. 6 99 , 115 . 64b 653,649. E a 65 Other liabilities (describe ► ) 1 BS � ; 66 Total Ilablittles (add lines 60 tltrough 65)-- :.. , ....:. , _.... .. _ . _. 699,515.1 88 1 654,449. Organizations that follow SFAS 117. theck mire 1", .�C rind complete lines 67 p through 69 and lines 73 and 74. 67 Unrestricted .. ....... ...:, .. ... .. . . 171 , 969. 87 150..110 . 8A 68 Temporarily restricted . .. .. • $d . . . . . . 69 Permanently restricted . . 69 Organtsations that do not follow SFAS 117, check here 0 and compiete Ivies R 70 through 74 w 70 Capital stock, trust pnnapal. or current funds . . . . . . . . . . . . . . . . . . ! 70 0 71 Paid4n or ca rtal surplus, or land, building, and . . . . . 72 Retained earnings, endowment, accumulated income, or other funds. 72 1 73 Total net assets or fund balances (add lines 67 through 69 or fines 70 through .. N 72, column (A) must equal line 19, oolumn (B) must equal line 21) . . 171,969. 7S 150,110 :... 74 Total liabilities and not assets/furtd balances (add lines 66 and 73) ....._... 871 , 484. ;74- :: :. 804 , 559: Form 990 is available for public inspection and, for some people, serves as the primary or sole source of inforTnatron about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part 111, the organization's programs and acoomplishments LTT•1 TEEA0103 01107/65 a Total revenue, gains, and other support N/A a Total expenses and losses per audited NSA. pit audded firtannal statements ► . i financial statements . . .. . .. . . . ► a b Amounts included on fine a but ` =' b Amounts included on line a but not not on line 12, Form 990 , '' on lime 17, Form 990 (1) Net unrealized ;;.=.' (1) Donated serv- gains on , " ices e investments $ y facilities , .. (2) Donated sere- - ` `;� (2) Prior year adjust - Ices and use mems reported on of facilities . . . $ line 20. Form 990.. $ (3) Recoveries of prxx (3) Losses repand on line 20, Form 990.. $ yyearg'ards . . . . $ ,, , . , f 3'_ �' ' ' • (4) Other (specify)' y� (4) Other (specify) ., f Add amounts on Imes (1) tivough (4) . . . ► b Add amourgs on Imes (1) through (Q .. . . r . b , C Line a minus line b . . . . . .. . . w C c Line a minus line b . . . . . . . .. ► e d Amounts included on line 12, ;?~ j py i': , ,�•`; d Amounts included on line 17, Form 990 but not on line a: Form 990 but not on line a: (1) Imestmem .;, r, •',y i .'. ,A� Invesimmerrt elrperrses • F� S _i;},-„ y 's" not included o ,;" • not included on line 'IF- . =' ,,��+rr• , '• �i• t+• lib. Farm 990 . . $ r r:s�frrC �rw r ,n, lib, Farm 990 $ �: -:..• err<y< 9. (2) Other (specify) (2) Other (specify)- s "•". �. `r• E. — — — — — — — — — — . Add amounts on lines (1) and (2) - ► d Add amounts on hh" (1) and (2) :. d e Total revenue per line 12, Form e Totalperline 17. Form 990 (line c pins lined) ► e (line a plus PartY I List of Officers, Directors, Ttrustees, and Key Lm 10 ees List each one even drtot see Instructions., Q tlk•ve if riot �i B 7 rtle and avers hours C} Compensation' 60 (In Expense, ( ) Per week devoted (ff not paid, employee benefit account and other A Name and address () to position enter -0-) plans and deferred allowances compensation See Attached ---------------------- Listing -- _ ------------ - - - - -- Various 0. 0. 75 Did arty officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than Q 810,000 was provided by the related organizations? . ...... .................. . . . P. Yes if 'Yes,' ariaclt schedule — see instructions BAA TEEA0104 at07136 ®No Form 9B0 (2004) Form 990 (2004) Enfield Fire Department 16-1334367 Pao&S I -NIA VI, I Other InfofrnatiOn (See instructions) Yes No . 76 Did the organization engage in any activity not previously reported to the IRSI tf 'Yes.' w . attach a detailed description of each activity . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. ... . .. 70 X T7 Were an changes made in the an" y ng org wig or governing documents but not reported to the IRS? . . . . ' tf 'Yes,' attach a conformed copy of the changes 78a Did the organization have unrelated business gross income 0( $11.000 or more during the year covered by this retum7 ; .. . 78' , X b if Yes.' has it flied a lax vellum on Form 990.7 for this year? ...... .. . , .. . . . : . .. , ..,.... . ... Ali X 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year' If 'Yes,' attach a statement . . .. .. .. ... . . . .. ... .. . . .. . . . ... Boa Is the organization related (other than by association with a statewide or nationwide organization) through cmnlilon membership, governing bodies, trustees, officers, etc, to arty other exempt or nonexempt organization? . . .. . .. 806 b if 'Yes,' enter the name of the organization ' .:X.� — — — — — — — _ j —— _ _.. --—————————-------�---- a _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and check Whether rt is exempt nonexempt 31a Enter direct and indirect political expenditures See One 81 instructions . . . ... 81x) 0. b Did the organization fee Form 1120-POL for this year . . . .... . . . . . . ..... . . . . . . . . . . . . . . . 1111 b X. " 82a Did the organization receive donated services or the use of materials, equipment: or facilities at no charge or at substantially less than fair rental value?. . . . . . ... ....... ... . . . . . . . . . . . . . . . . . . 82a X b if 'Yes,' you may indicate the value of these items here. Do not include this 4nnotint as I revenue in Part I or as an expense in Part It (See instructions in Part 111.) , ........... 82bl 83a Did the organization comply with the public inspection requirements forreturns and exemption appiicadonsh .. `: :.... 83x. X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions 84a Did the organization solicit any contributions or grfts that were not tax deductible?........ .... 444 _ b If 'es,' did the organization include with every solicitation an express statement 0tat such cattritwbons or gift were ... .. ... .. .. .. not tax deductible? . ... . ..... ... ...... .. ......... ..... .. .. 84b 85 501(4)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members? . .... _ ..• ......... t3Sa Nr(j� b Did the organization make only in-house lobbying expenditures of $2,000 or less? . ..... , ..... .. .:.:.. 8Sb N/ If 'Yes' was answered to either 85a or M, do not complete BSc through 85h below unless the organizadoh--mo hied a - waiver for proxy tax owed for the prior year c Dues, assessments, and similar amounts from members ...... - ....... ..... 854 d Section 162(e) lobbying and political expenditures . .. . . . .. . . . . .... . . . . . . . _688 e Aggregate nondeductible amount of section 6033(ex1 XA) dues notices. . .... . . . . . . 33a " f Taxable amount of lobbying and political expenditures (line 85d less 85e). .... . ...... 85f g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? . . . . . .. . . . . . . . . . . . . .. d5 .. N i, In if sedton 6G33(e)(1)(A) dues vetoes were sent does the organiza ion agree tii add the arnou d online 85f to as reasonable estimate of dues allocable to nondeductible lo" and political expendcnrreslarthe lollo" taxyear7 . . . . . . . . . . . . . . . . . . ...- 88 501(4)(7) organizations Enter a Initiation fees and capital contributions included on linei2 ............................... ......... . N/A b Gross receipts, included on line 12, for public use of dub facilities ... , .... . , . 87 501(4)(12) organizations. Enter a Gross income from members or shareholders. . . . Isla Ni/A b Gross income from other sources (Do not net amounts due or paid to other sources: I against amounts due or received from them ) . . . . .. . .. ... . . . . . . . . . . . . . tirtb N/A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporadomor partnership, or an entity disregarded as separate from the organlzabon under Regulations sections 301.7701-2 and 301 7701-3? if 'Yes,' complete Part IX .. . ... .... . ... .. ........ . . .. .. .... , ....... ...... .. .. 88 X 89a 501(4)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 ► 0. , section 4912 r• 0, ; section 4955 ► 0. b 501(4)(3) and 501(4)(4) organizations. Did the organization engage in arry section 408 excess benefit transaction from lf'Yes; during the year or did it become aware of an excess benefit transaction a prior year7 attach a statement explaining each transaction . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . t(eb - X c Enter Amount of tax imposed on the organization managers or disqualified pentons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . • . . . . . . . . . ► 0. d Enter Amount of tax on line 89c, above, reimbursed by the organization' , .. . . .. . . . . . . . . . . . . . s 0. 90a List the states with which a copy of this return is flied ► None rtitlp'_0 b Number of employees employed n the pay period that Induces March 12, 2004 (See instructions.) .. .. . .. .. . .. 91 The books are in care of ► Sherry Be rgZYen _ _ _ Tlilephone number ► (6 0_7) — 2_7_2 - 8`/_S7 Locatedat► 172_ E_nfi_eld__Main _Ad_.�, �t_hac_a _NY _— _--__- _ __ ZIP ► 14850 _ _ - - - - - - - i filing Form 990 lieu Form 1041 — Check here 92 Section 4947(x)(1) nonexempt charitable trusts in of . ..... .. .. . eot interest received or accrued during the tax year ... -.._ , .... , , �� 82 and enter the amount of taxexm ;.,, -- BAA Form 9W (2004) TFEAa105 O1r07r05. -. ..... ..... ...'i... Organization Exempt-Under OMB No.1 4koo SCHEDULE A (Form`980or990-EZ) Section 501(c)(3) (Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n), or Section 4447(a)(1) Nonexempt CharttabM Trust 2004 . Supplementary Information — (See separate Instructions,) - Imernal sre�ry MUST be completed the above -- P by organizations and attached tollJleirForm 890 or 880#Z - - . Name of ft agaMwaion Employer klend smon r numbs )infield Fire Department 16=1334367 Pait•i Compensation the Five Highest Paid Employees Other Than Officers, 'l+sctora, and TmOses (See instructions. list each one If there are none, enter'None') mof (a) Name andaddresseach (bh Title and average(c) Compensation -�(d) C (o) Expense psi ore than $50,000 devoted to position emplowe A plans affi deferred account and other allowances None 0 Total number of other employees paw over $50,000. . . . .... . .. . ► None, _ pe s Pe I Part iia " 1 Compensation d the Fare Highest Paid Independent Contractors for Pcat+assional Services (See instructions, list each one (whether individuals or firms) if there are none, enter'None.) (a) Name and address of each independent t anhidw paid mom than $50,000 (b) Type of" „. (ip Coftloonsetion None Total number of others receiving over $50,000 for professional services . . . . ► None BAA For Paperwork Reduction Act Notice, see the Inutmcdon for Fort 890 and Form 8804E7- 7Eeaaw, 07* M f .. S Z Schedule A (Form 990 or 990 -EZ) 2004 Enfield Fire Department 16-1334.367 Pagel Pafflib, ;e°,l Statements About Activities (See instructions) YM No 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to Influence public opinion on a legislative matter or referendum? lf'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities . ► $ (Must equal amounts on line 38, Part VI -A, or line i of Part VI -B ) ............ . ... .. . .. . .. . 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI -A. Other organizations checking 'Yes' must complete Part VI$ AND attach a statement giving a detailed descripbon of the lobbying activities 2 During the year, has the organization, either directly or indirectly, engaged In any of the following ads with any . substantial contributors, trustees, directors. offxws, creators, key employees, or members of their faniies, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majontyowner, or principal beneficiary? (ff the answer to any question is 'Yes,' attach a detailed statement explahniry the &V44adr M-) a Sale, exchange, or leasing of property. . . . .. . .... .. ... . .. .. . ... .. . . . . . 2a X b Lending of money or other extension of credit? . .... . . ... . . . . . . . . .. . . ... . .. .. . .... ... . . 2b X c Furnishing of goods, services, or facilities? . ...... .. .... ......... .. ......... .. . d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? ...... . . , . . ..... 2c X ....... 2d % f e Transfer of any part o1 Its income or assets? . . . . . . . .... . ... .. . . . . . . . . . . . . . . . . . . . 2e X 3 a Do you make grants for scholarships, fellowships, student loans, etc? (if'Yes,' attach an explanation of how you determine that recipients quarrfyto receive payments ) . . . . . . . . . . .. . . . . . . . . . . . 3a G - b Do you have a section 403(b) annuity plan for your employees? _ . . . . . . . .. . .. . . . . . . . . . . 3b 4 a Did you maintain any separable account for partidpabng donors where donors have the right to p" advice on the use or distribution of funds? .. . . . ...... . .. . . . ... ... .. ... . . .. .. . 4;1 X j b Do you vide credit counseling, debt Y Pro ng. management, crad't repair, or debt nOpotiation.thervices? . .. ... .. 4b X- - I PartFV Reason for Non -Private Foundation Status (see Instructions) The wanization is not a private foundation because it is (Please check only ONE applicable box ) 5 A church, convention of churches, or association of churctm Section 170(bXlXAXi) _ 8 A school Section 170(bX1)(A)(ii) (Also complete Part V.) ' 7 A hospital or a cooperative hospital s"ce organization Section 170(bX1XA)(Si). , 8 _ A Federal, state, or local government or governmental unit Section 17O(bXIXAXV) 9 i A medical research organization operated in conjunction with a hospital Section 170(bX1XA)ar) Enw the hasphirs name, efty. and state 10 An organization operated for the benefit of a college or universityowned oropefated by a govemmentef unit Section 170(bX1XA)(v) (Also complete the Support Schedule in Part N -A ) Ila © An organization that normality receives a substantial part of its support from a govemmentai unit or from the general public Section 1 70(b X 1 XAXv i). (Also complete the Support Schedule in Part [VA.) lib F] A community trust. Section 170(bXI XAXvi). (Also complete the Support Schedule in Part IV -A ) 12 7 An organization that normally receives- (1) more than 33.1/3% of Its support from oontributions, membership fees, and gross receipts from activities to its functions — to certain exceptions, end (2) no more than 33-113% its related charitable, etc, subject of support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(aX2) (Also complete the Support Schedule In Part IV -A ) 13 ❑ An organizebon that is not controlled by any disqualified persons (other than foundation managers) and supports„ an"¢ations described 1) lines 5 through 12 section 501(c)(4), (5), or (S), if they meet the test of sedan 508(a)(2)', (See in above; or (2) sectlon 509(aX3)) Provide the following information about the supported organizations- (See instructions ) (a) Name(s) of supported organ'ization(s) (b) Line above s Schedule A (Form 990 or 9WEZ) 2004 Enfield Fire Department 36-1334367 Page 3 (Part PV-A ISupport Sche ule (Complete only if you chedwd a box on line 10, 11, or 12) use cash RM1100d ofaccoan ft. Note: You may use the worksheet in the 'instructions for come irp�fiom the accrtraIF h the cash method of accow►er►Q Calendar year (or fiscal year (a) (c' 2003.. 2(7062 2001 begtnNng in) . ► ) T�oalal... 15 Gifts, grants, and contributions unusual grants not SInclude e lli ee28 233,370, _ 2-55,304- 210.244., .187,240_ 804,152.- 16 Membership fees received , . . . 109. 297,, 156. 143. 705. 17 Cross receipts from admissions, merchandise sold or serwces performed, or tumshing at faddies in any activity that is related to the organrzanw's charitable, etc, puts • • . • • • • • 7,101; - 8,311. 15,.113: 15,800. 46,925. 18 Gross income from interest, dn+derds, amourm recewd from payments on secu les loans (section 51 T(a)(5)). reran, Mrftles. and unrelated business taxable income (les semen 511 taxes) from businesses acquired by the orgao- 2atnonalterJune30,1915 797. 1,-67ty, 3,288: 2,763_. 8,518. 19 Net income from unrelated business activities not included to lute 18. . . .. 0 , 0 . 0. 20 Tax revenues levied for the organbzaifon's benefit and either paid to it or expended on Its behalf . . . ... . ... . 0 . 0 . 0. 21 The value of services or facilities furnished to the or by a governmental unit withart charge Do not include the value of sennices or facilities generally furnished to the public without charge .. . . 0 . 0 ._ 0. 0. 0 22 Other income Attach a schedule Do not include gain or (loss) from sale of . capital assets.. . .. :. ... 0. 0 0. 0, 0 23 Total of fines 15 through 22.... 241_,977. 265, 582. 236,'801: ZO5 996 _-� 950; 30 24 Line 23 minus line 17..... _ . 234,276. 251 271 221, 688.1 190.,146,.381,- 25 Enter 1% of line 23 . . . . . . . 2,420. 2,656,1 2,368. 26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), fine 24 . . . . _ b Prepare a Its: for your records to show the name of and amourt catlntxned by each person (other dean a g0verrinneWl unit or publicly supported arganruition) whose total grh for 2000 through 2003 exceeded the amours shown in tine 26a. Do not fib this FM go row retain. Enter the total of all these excess amounts ........ ..:.: .. . .... ....... .. .... . . r 26b c Total support for section 509(axi ) test Enter line 24, column (e) .. . . . . . .. . . . . . . . . . . . . . .. ► 28c 903 3.81". d Add: Amounts from column (e) for lines 16 8,5.18. 19 D 22 0. 26b r Z6d 8, 518 e Public support (fine 26c minus line 26d total) ........ . .... . ... . . ... ... s ► 213e 694 "83 . f Public support percentage (line 26s (numerator) dfirMod.byline 26c (denominator)). . . .. . . . . . . . . ► 20 ( 99 A: $ 27 Organizations described on line 12: a For amounts included in Innes 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the name of, and total amounts received in each year from, each 'disqualified person ' Do not file this list with your return. Enter the sum of such amounts for each year. (2003) _ _ _ - - (2002) _ _ _ _ _ _ _ _ - _ (2001) _ _ _ _ _ _ _ (2000) b For any amount included in line 17 that was recervecifrom each person (other thari'disqualffied persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on Cine 25 for* year or (2) $5,000. (include in the fist organizations described in lines 5 through 11, as well as individuals ) Do not ole this list tNitl1 your velum. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the star of these differences (the excess amounts) for each year (2003)------------ (2002)_-----------(2001)------------(2000)------------- c Add Amounts from column (e) for lines 15 16 17 20 21 -4 27, d Add. line 27a total ... andline270 total ..... . _ 27d e Public support (line 27c total minus line 27d total). ,. ...'... ... .. . . . ► 27e f Total support for section 509(ax2) test Enter amount from line 23, column (e) 27f g Public support percertage (nne 27e (numerator) divided by Ilne 27f (denominator)) h Investment Income percentage (line 18, column (e) ( sulgtarator) divided by One 27f (denominator)). A 28 Unusual Grants: For an organastion described in tine 10, 11, or 12 that received any unusual 9rar1ts during 2000 through 2:003, prepe-re a ' list for your records to show, for each year, the name of the conblbutexr, the date and amount of the grant, and a brief description oilhs nature of the grant Do not file this fist YsM your tietutun oo trot inoludd theae grants in line 15- BAA TEEM4M 07M01 Schedule A (Form 990 or 980-E4 2004 Schedule A (Form 990 or 990 -EZ t 2004 En i e I d Fire Department 16-1-334367 Page 4 t, 1Parw-1 � Prnrate School Questionnaire (see hstructions.) (To be completed ONLY by schools that checked the box on line 6 I Part N) N/A you No 29 Does the organization have a racially nondiscriminatory poticy toward stude►ris by statement in its charter. bylaws, other governing Instrument, or in a resolution of its governing body? . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and sdwiarships? . .. . .. . . . . .. ........ ........ .. . ... .. . .. . . . .. _ ..... , .... 30 31 Has the organization publicized its racially nondiscriminatory pdicy through newspep8r or broadcast media dudrig the solid tation for students, or during the registry # it period of period no tation program, in a way:" makes the policy known to all parts of the general community it serves? .... ............. ......... .. 31 If 'Yes,' please describe, it'No,' please explain (If you need more space, attach a separate statement) - - - - - - - - - - - - - - - - - - - - - - -- - - ----- - --------------------------------_-.._....-_.. - ------------------------------------------------------ 32 Does the organization maintain the following. a Records Indicating the racial composition of the student body, faculty, and administrative staff? . . . . . . .. . ... ... . 32a b Records documenting that scholarships and other financial assistance are awarded an a racially nondiscriminatory besisl . .. ..:. :.:, .. . . .. .... .: . .. 33b c Copies of all catalogues, brochures, announcements, and other'wrritten communications to the publild dealing with student admissions, programs, and scholarships? . . ..... . . .. . . . . . . . .. . . . . . . . . . .. . . 32c d Copies of all material used by the organization or on its behalf to solicit contributions) . . . . . . . . . . . . . . . . . .. . . 32d If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement) ---------------------------------------------------------- 33 Does the organization discriminate by race in anyway with respect to a Students' rights or prrvileges?. . . . . . . . . . . .. . . . .... . . . . . . .. . . . . .. b Admissions polides'� . . . . . . . . . . . . . . . ... .. . .. . , . . , .. . . . .. . . . c Employment of faculty or administrative state . . .. . . .. .. . . . . . . . . . . . . . . . . .. . 3.3e d Sdmlarships or other financial assistance? . . . . .. . . . . .. . . . .. . . . . . e Educational policies? . . . . . . . .. .. . . . . ..... . . . .. .. ... .. ...... ... ... f Use of facilities? . . . . . . . . . . . . . . . . . . . . . . .... . . . . .. .. . . . . . . . . . . . .. . . _ 33f 9 Athletic programs' . . . . . . . . . . . . . . . . . .. . . ..... .. . .. .. ... . .. . .. . . . . ... . . h Other extracumcular activites? . .. . . . . . .. ... . ... .. .. ... .. 33h If you answefed 'Yes' to any of the above, Please explain (If you need more space, attach a separate statement ) ---------------------------------------------------------- 34a Does the organization receive any financial aid or assistance from a govemmental agency' ....... ........ 348 b Has the organization's right to such aid ever been revoked or suspended? ...... . . . . .. . . . . . . . . . . . . . .. 34b If you answered 'Yes' to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,19752 C.B 567, covering racial nondiscrimination? N 'No,' attach an explanation_ , . ... . . . . . . . . . . . . . 35 .. Schedule A (Form 996 ar Zile -€Z, 2 BAA >EEAo-wr 07r23ah Schedule A (Form 990 or 990 -EZ) 2004 Enfield Fire Dep&rtmept 16-1334367 page's IPart`Vi=14} Lobbying E2enditures by Electing Public Charities (see Instructions) (To be completed ONLY by an eligible organization that filed Form 5768) _ N/A Check ► a n if the organization belongs to an affiliated gnx* Check ► b ff you checked 'a' and 'limited control' Provisions apdy Limits on Lobbying Expenditures Afftliatwgroup To be (b)group (The tern 'expenditures' means amounts paid or incurred) totals for ALL electing organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) . . . . . . . 38 'l. 37 Total lobbying expenditures to influence a legislative body (direct lobbying) . . . . . . . 38 Total lobbying expenditures (add lines 36 and 37) . . .... . . . . .. . . . . 38 39 Other exempt purpose expenditures .' 40 Total exempt purpose expenditures (add lines W and 39). . . . .. . ... 10 41 Lobbying nontaxable amount Enter the amount from the following table — if the amount on line 40 Is — The lobbying nontaxable amount Is — Not over $500,000 . . . . . . . . . . . . . 20% of ft amount on line 40 ... . Over S500,000 but not oyer $1,000,000 . . . . . . S100,000 pips 15% d Cue eaoess over 5500,000 Over $1,000.000 but not over 51,500,000 . . . . . $175,000 plus 10% of the excess over $1,000,000 — 41 Over 57,500.000 but rot over $17,000,00D . _ ... $725,000 plus 5% of Cie euess over $1.500.000 I Over $17,000,000 . . . .. ........51,000,000 7j 42 Grassroots nontaxable amount (enter 25% of line 41).: ... 42 43 Subtract line 42 from line 36 Enter -0- if line 42 is more then line 36 .. I _ 44 Subtract line 41 from line 38 Enter -0' If line 41 is more than One 36 44 Caution: N there is an amount on either fine 43 orlure 44, you mtot hie Fafi 4220 4 -Year Averaging Period Under Section 501(h) ' (Some organizations that made a section 501(h) election do not have to complete all of the five,columris bebw. . See the instructions for lines 45 through 50 ) Lobbying Etpendlturas During 4 Year Arara)Dhp krlod Calendar year (a) (b) M ( (eT (or fiscal year 2004 2003 2002. 2001. Total beginning in) > 45 Lobbying nontaxable amount ......... ! 46 Loma nounpge)). .(1 Othe � F 47 Total lobbying expenditures . . . . . .I I 48 Grassroots non- taxable amount. . . . . 49 Grassroots ceiling amount .', ; s (150% of line 48(e)) . . . ._ 50 Grassroots lobbying e)pendihrres . . . . . . (Part VI=Ir�`.I Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that d6not complete Part VI -A) (See rnstruddo"s.) During the year, did the organization attempt to Influence national, state or local Wgislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of yds No Amount a Volunteers . .:. ... ... .. . b Paid staff or management (include compensation in expenses reported on Imes a through h;) :.... . `.. , c Media advertisements .. d Mailings to members, legislators, or the public . . . . . . . . . . .. . . ... . . . .. :-. e Publications, or published or broadcast statements . . . . . . . . . . . . f Grants to other organizations for lobbying purposes. . . ... .. , . g Direct oonlact with legislators, their staffs, government aftkials, or a legislative body .. ......<. . h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means ....... , I Total lobbying expenditures (add lines c through h.).'r , ., .. . ... . . .... . . .. `. . If Yes' to arty of the above, also attach a statement givinfl a defiled desaiptgnof lute lo¢pyirtp activities SAA WEdufe A (Farm *Or 880� TIFEAD s 07mmr Schedule a (Forth M or 990-M 2004 Enfield Fire Department _ _ 16-1334367 " Page 8 IPart Vll,,I information Regarding Transfers To and Transactions and Relationships With Noncharitams, Exempt Organizations (See instructions) 51 Did the reportng organization directly or Ind m Indirectly engage any of the following with any other organization described in section 501(c) ' of the Code other than section 501 c3 ( (x) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitabie exempt organization of - — Yes No (1) Cash . . . . . . ... . ... . . . . . .. ....... ... .... . . .. 51a (q 1 X 01) Other assets . . . . . . . . . . . . . . . . . . . . . . ... . . ... ... . . . .. . .. . . . . .. .a(8) • X b Other transactions: (1) Sales or exchanges of assets with a noncharitabie exempt organization . . . , . . , , ,6 1 .... . ., X (II) Purchases of assets from a noncharhable exempt organization . . . . . . . . .. . .. ... .. .. ..... b (i) It (111) Rental of facilities, equipment, or other assets :.., . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .... b(041 -X _ (Iv) Reimbursement arrangements . . . . . . . . . . . ..... . . . .. . . . . . . , X (v) Loans or loan guarantees . . . . . . . . . . . . ... . . .. . . . . . . . M— (A)Performance of services or membership or fundraising sdidtations. . . . ...:. . .. . . .. .. b (r() X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees.... ; . ; . c X it tf the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of thegoods, other assets, or services given by the re organization If the ani ation received less than fair market value in any iransadion or shannq arran aemerrt, show in column�jd) me value of the s, other assets, or services received ab ( Line no Amount involved Narmatnondiaritat%e)Desrn«m exempt organization ptottranst6j.Varom,andshanrg.. I I I 1 I kk I _ I. I I' 52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organi2ations described In section 501(c) of the Code (other than section 501(cx3)) or in section 527 .. ►.Q .K No b If Yes,' complete the following schedule a Name of organization Type of organization Deacfiptior��of relailidnsFup I " I. BAA Sthdule A .Mbirm 890 of Wo 40 TZEAwes 11MIX Enfield Fire Department 16-1334367 7 . Form 990, Page 2, Part 11, Line 43 Other Expenses Stmt (A) (B) (C) (D) Other expenses not Total Program Management Fundraising covered above (itemize). services and general Insurance 38,161. 35,161. 3,000. 0. Health & Saftey 3,684. 3,684. 0. 0. Total 41,845. 38,845. 3,000. 0. Form 8868 (Rev 12-2004) Enfield Fire Department 16-1334367 Pae 2 a If you are filing for an Additional (not automatic) 3 -Month Extension, complete only Part 0 and check this box ► X Note. Only complete Part 8 if you have already been granted an autamatfc 3 -month extension on a previously filed Form 8868 a If you are filing for an Automatic 3 -Month Extension, complete only_Part I (on page 1) I Part H AddRional (not automatic) 3 -Month Extension of Time — Must File Original and One Copy. Name of Exempt Organization Erriployendentification number Type or print Enfield Fire Department 1-6-1334367 Numrref sir eel and room or suite number it a P O box we. insliuctions - Fol RS use only - - - File oy Ine - - - - - extended - diingdUte for 72 Enfield Main St. f velum See Cd town or post office, state and ZIP code For a fora n address see instructions rnShuChpnS r 4 - - Ithaca NY 14850 Check type of return to use filed (File a separate application for each return) X Form 990 Form 990-T (section 401 (a) or 408(3) trust) Form 5227 Form 990 -BL Form 990-T (trust other than above) Form 6069 . Form 990 -EZ Form 1041 •A Fortin 8870 Form 990 -PF Form 4720 STOP; Do not complete Part It if you were not already granted an automatic 3 -month extension on previoualy ided orm 8868. - a The books are in care of ►_S_herry.Ae rggiren_ _ _ ` _ _ _ _ _ - _ - _ - - - - - - Telephone No ► (607)_272-8_757--___ FAX No ► -_ ___ a If the organization does not have an office or place of business in the United States, check this box .. '►El a If this is for a Group Retum, enter the organizations four digit Group Exemption Number (GEN) N/A if this is for the whole group, check this box ► If It is.part of the group, check this box ► and attach a list with the trances acid VINs of all members the extension is for 4 1 request an additional 3 -month extension of. time. unfit Nov IS- - .20:05. 5 For calendar year _200_4 or other tax year beginning _ 20 _ and ending _ _ _ _ _ 20 6 If this tax year is for less than 12 months. check reason InlfiaI return Final return Change in accounting period 7 Stale in detail why you need the extension Cat_a_ necesar to Comre lie_ the turn _ has not beer. fully assembled ____ - y_ __- _- - - - _ -- -- - -- -- _ --------------------_.-------------____._.�-�-- ----------------- 8a If this application is fol Form 990-13L. 990 iii .990 T, :720, -0f-660, n-ler, the tentative tax, less ar-y_ nonrefundable credits See instructions S 0. b If this application is for Form 950 -PF. 990•T 4720. or 5069, enter any refundable` credits and estimated tax payments made Include any prior year overpayment allowed as a credit and arry amount paid pfeviously'with Form 8868 0. c Balance Due. Subtract line 8b from line 8a Include your payment with this form, or. if required. deposit with FTD coupon or, it required, by using EMS (Electronic Federal tax Payment System) See instructions S 0, Signature and Verification Under penatties of peiiur crate that f have ex@ e97 this roan and idmp actompanyi: schedules and statements and to the best of my knowtedge and belief it is true correct and c We 1 7 in authors this form Titre 1 / Srgna•,� _ - _ . Date.► /l Notice to Applicant --To be Completed by the IRS We have approved this application Please attach this form to the organization's return We have not approved this application However, we have granted a 10 -day grace period from the later of the date shown below or the due date of the organization's return (including any prior extensions) This grace period is considered lobe a validextension of time for elections otherwise required to be made on a timely tiled return Please attach this form to the organization's return: n We have not approved this application After considering the reasons stated in item 7, we cannot grant your request for an extension of -" time to file We are not granting a 10 -day grace period We cannot consider this application because it was filed after the extended due date of the return for which an extension was requested Ocher -------------------------------------------- ------ sy" o,reclor - - - - Date nn rlV 11 Altemate Mailing Address -Enter the address If you want the copy of this application for an additional 3 -moth ft leturned to an' address different than the one entered above Name - - -- 004 Type Or jNumber and street (include suite to". or apartment number) or a P 0 b omox ra"er print City Ortown. province or state, and country (including postal or ZiP code) BAA FIFZ0502 01/04/05 Form 8868 .(Rev 12-2004)