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I ShOft FOTITI oivie No 1545-1150
" " Return of Organization Exempt From Income Tax
I
(except black lung benefit trust or private the Internal Revenue Code 0 9
Form I Under section 501(c), 527, or 4947(a)(1) of foundation)
L Sponsoring organizations of donor advised funds and controlling organizations as defined in section
assets less than $1,250,000 All other ofthe year may gross receipts
Department of the Treasury 512(b)(13) must file Form 990at the endorganizations withuse this fomi less than $500,000 and total Open to public
lmemai Revenue Se,-wee P The organization may have to use a copy of this retum to satisfy state reporting requirements Inspection
A For the 2009 calendar ear, or tax ear beinnin , 2009, and ending
B Checkifapplicable Please C Name of organization D Employer identification number
use IRS
- Address
change label or
I Name change print or Posey Townshlp Clay County Volunteer F1 re Department Inc 3 5- 60 4 60 9 9
I Initial retum
I Termination
Amended
retum
type.
See
SpeciEc
PO Box 32 812-448-8150
Number and street (or P O box, if mail is not delivered to street address) Room/suite E Telephone number
Instruc City or town, state or country, and ZIP + 4 F Group Exemption
IN trusts must attach G Accounting method P
II?ItjI*I*IfI**e" Staunton, charitable47881 Number- -Ii-I-Cash I*-IAccrual
tions.
0 Section 501(c)(3) organizations and 4947(a)(1) nonexempt
a completed Schedule A (Fonn 990 or 990-EZ). Other (spemfy) 5
H Check P LI if the organization is not
I Website: P required to attach Schedule B (Form 990,
J Tax-exem tstatus (check only one) - I X I 501(g)-(4 ) 1 (insert no)J I 4947(a)(1) or I I 527 990-EZ, or 990-PF)
K Check P LI if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000 A
Form 990-EZ or Form 990 return is not required, but if the organization chooses to file a return, be sure to file a complete return
L Add lines 5b, 6b, and 7b, to line 9 to determine gross receipts, if$500,000 or more, file Form 990 instead of Form 990-EZ , I D 5 6 6 , 7 7 9 . OO
m Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I )
1 Contributions, gifts, grants, and similar amounts received I I I I I I I I I I I I I I I I I I I I II I 1 6 i 024 OO
Program service revenue including government fees and contracts I I I I I I I I I I I I I I I II I 2 4 4 i 4 7 1 OO
Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 3/ 0 60 OO
Investment tneeme . . . . . . . . . . . . . . . . . . . . . . . .. . 21 4 1 8 OO
a Gross amount from sale of assets other than inventory I I I II I 53 2 i 2 4 4
b Less cost or other basis and sales expenses I I I I I I I I II I 0 - 0 0
OO
C Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . . . . . .. . 50 2 i 2 4 4
6 Special events and actiwties (complete applicable parts of Schedule G) If any amount is from garnlng, check here I I I P IJ
a Gross revenue (not including $ of contributions
8/ b , O
reported on line1) I 58 6 362-OO
b Less direct expen es otheI4g7lIbE1(i3rE3ie,i41E@nses I I I I I 4 560 - O OO
c Net income or (los )qfIr am1c tg (Subtract line 6b from line 6a) I I I I I I I II I 66 3 I 3 02
b I-BSS C051 inv nga , lesfeturgs . . . . .. . " . , .
7 a Gross sales ofOf 9005 S01 . . . . . . indgboman .I .I.. ,, I Z:
Other revenue (debc be 44)1l&1E,I-I%A$&QU5 .I II . 7c .. . t 3 219 OO
Gross I
8 cTotalprofit or (lo s) gcc?-.555lIt?6f1Imientery(,521,ine ,7b. from.line.7a).I .I I.I .I I. I.I .I I.INCOME9) 62,200 OO
9 revenue. Add lines 1, 2, , , . . . . . .
10 Grants and similar amounts paid (attach schedule) I I I I I I I I I I I I I I I I I I I I I I I II I 10
11 Benefits Paid to of for members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 1 1
12 Salaries, other compensation, and employee benefits I I I I I I I I I I I I I I I I I I I I I I II I 12
13 Professional fees and other payments to independent contractors , , , , , , , , , , , I , I I I II I 13
14 Occupancy, rent, utilities, and maintenance I I I I I I I I I I I I I I I I I I I I I I I I I I II I 14 3 1 4 7 9 OO
15 Printing, publications, postage, and shipping I I I I I I I I I I I I I I I I I I I I I I I I I I II I 15
16 Other expenses (descnbep SEE ATTACHED SHEET ) 16 50, 425. OO
OO
17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . . . . . . . . . . . . . .. . p 17 5 3 , 90 4
18 Excess or (deficit) for the year (Subtract line 17 from line 9) I I I I I I I I I I I I I I I I I I I II I 13 3 i 3 1 5 OO
19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior years return) I I I I I I I , I I , , , , I I I , I , , I I I ,, , 19 186,412.00
20 Other changes in net assets or fund balances (attach explanation) I I I I I I I I I I I I I I I I II I 20
21 Net assets or fund balances at end of year Combine lines 1B through 20 . . . . . . . . . . .. . P 21 1 9 4 , 7 27 , OO
m Balat1C6 Sheets. If Total assets on line 25, column (Q) are $1,250,000 or more, tile Form 990 instead of Form 990-EZ
(See the Instructions for Part ll ) (A) Begtftntng Of Yeef (B) End Of Yeaf
22 Cash,savings, and investments I I I I I I I I I I I I I I I I I I I I I II I 103/ 670-00 22 126/ 314 OO
21 ., 00 21 , 00
/of/C?)
23 Land andbuildmgs . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 15f266"OO 23 14/857" 00 OO
24 Qmer assetswescnbe , EQUIPMENT & VEHICLES I 67, 476.00 24 53, 556.
25 Tetetessets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 186/412-00 25 194,727.00
26 Total liabilities (descnbe L ) 26 4 1 2 . 1 94 7 2 7 .
Net assets or fund balances (line 27 of column (B) must agree with line 21) 1 8 6 ef
QEIO-5343 000 For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions. Form 990-EZ (2009),
7
Form"99o-Ez (2699) Page 2
m Statement of Program Service Accomplishments (See the instructions for Part lIl,) Expenses
What is the organizations primary exempt purpose? FI RE PROTECTI ON I-,Tyiquned fordsggtaon
(C)(3) H" (C)(4)
Descnbe what was achieved in carrying out the organization"s exempt purposes In a clear and concise manner, organizations and section
4947(a)(1) trusts, optional
describe the services provided, the number of persons benefited, and other relevant information for each program title for others)
28FIRE PROTECTION FOR TOWNSHIP RESIDENTS AND PROPERTY
(Grants $ 0 - 00 )lf this amount includes foreign grants, check here . . . . .. . p I I 28a 4 2 1 0 96 - 00
29
(Grants$ )If this amount includes foreign grants, check here . . . . .. . p I I 293
30
-(Grants $ ) lf this amount includes foreign grants, check here . . . . .. . p I I 303
31 Other program services (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
(Grants $ ) lf this amount includes foreign grants, check here . . . . .. . p I-I 31a
32 Total program service expenses (add lines 28a through 31a) , , , , , , , , , , , , , , , , , , , , ,, , p 32 4 2 , O 96.00
List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated (See the instructions for Part lv)
(b) Title and average (c) Com ensation (dl C0"l"b""0"5*0 (e) Expense
(3) Name and address hours per week (If no? paid, emplevee beneif Plane 8- account and
ROB GAMBILL PRESIDENT devoted to position enter -0-.) deferred compensation other allowances
417 E STAUNTON RILEY ST BRAZIL,
CHAD MILLER VICE PRESIDENT IN 47834 5 0.00 0.00 0.00
403 w PLEASANT ST Box 85 STAUNTON, IN 47881 5 0.00 0.00 0.00
DAVE STALEY TREASURER
4114 W PR 71ON BRAZIL, IN 47834 5 0.00 0.00 0.00
MELISSA GAMBILL SECRETARY
417 E STAUNTON RILEY ST BRAZIL,
LARRY TEMPEL FIRE CHIEF IN 47834 5 0.00 0.00 0.00
7637 N CR 425 W BRAZIL, IN 47834 2 0.00 0.00 0.00
MELANIE BROWN DIRECTOR
4190 W PR 710 N BRAZIL, IN
MIKE HEATON DIRECTOR 47834 2 0.00 0.00 0.00
4475 N
NORMMEADOWWOOD DR BRAZIL, IN 47834 2 0.00 0.00 0.00
JOHNSON DIRECTOR
CR 425 W BRAZIL, IN
7334 NBARNARD DIRECTOR 47834 2 0.00 0.00 0.00
CODY
P.O. BOX 12 KNIGHTSVILLE,
MATT BARKER DIRECTOR IN 47857 2 0.00 0.00 0.00
7346 N CR 425 W BRAZIL, IN 47834 2 0.00 0.00 0.00
JSA Form 990-EZ (2009)Qs ,
9E1009 2 O00
#erm soo-E"z (zoos) Page 3
W ,Other information (Note the statement requirements in the instructions for Part V.)
Yes No
33 Did the organization engage in any activity not previously reported to the IRS? lf "Yes," attach a detailed
USSCFIPUOU Of each 3CfiViiY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 33 X
34 Were any changes made to the organizing or governing documents? If "Yes," attach a conformed copy of
the eheiieee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 34 X
35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but
not reported on Form 990-T, attach a statement explaining why the organization did not report the income on Form 990-T
3 Did the organization have unrelated business gross income of $1,000 or more or was it subject to section
6033(e) notice, reporting, and proxy tax requirements? , , , , , . , I , , , I , , I , I I I , , , . . , , , ,, , 35a X
b If "Yes," has it filed a tax return on Form 990-T for this year? , , , , , , I , , , , , , , , , , , , I I , I , . I, , 35b
36 Did the organization undergo a liquidation, dissolution, termination, or signihcant dosposition of net assets
during the year? If "Yes," complete applicable parts of Schedule N . . . . . . . . . . . . . . . . . . . . . . .. . 36 X
37a Enter amount of political expenditures, direct or indirect, as described in the instructions P
b Did the organization file Fomi 1120-POL for this year? , , , , . I , , . I . I - I . , I , , . I I I , I , , I ,. I 37b X
38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the period covered by this return?, , , , " "
b If "Yes," complete Schedule L, Part ll and enter the total amount involved , , , , , ,, , 38b
39 Section 501(c)(7) organizations Enter
a Initiation fees and capital contributions included on line 9 I , , , , , I , , , , , I II , M
b Gross receipts, included on line 9, for public use of club facilities , , , , , , , , , ,, , w
40a Section 501(c)(3) organizations Enter amount of tax imposed on the organization during the year under
section 4911 p , section 4912 p , section 4955 p
b Section 501(c)(3) and 501 (c)(4) organizations Did the organization engage in any section 4958 excess benefit
transaction during the year or is it aware that it engaged in an excess benefit transaction with a disqualified
person in a prior year, and that the transaction has not been reported on any of the organizations prior
Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I , , , , , , , , , I , ,I ,
C Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax imposed on
organization managers or disqualified persons during the year under sections 4912,
4955, eiid4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . P 0.00
d Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax on line 40c
reiriibiireed bv the erseriileiieri . . . . . . . . . . . . . . . . . . . . . . . . .. . P 0.00
e All organizations At any time during the tax year, was the organization a party to a prohibited tax shelter
ffaiiSaCti0n"7 If "YeS." COFUPISTB F0fm 3836-T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 1.1.
41 List the states with which a copy of this return is filed P INDIANA
428 The 0i9a"iZafi0""S books ale in Cafe Of 5 ..l.3.5YE...$.T.5Pl"3.X .............................. .. Telephone no * ...3l,2.1.4..4.3.T.f.3.Qf?.Q ............ ..
Leeeied ei P4 .1..1..*%...lil,.5%..ll.Qjif....i?l??i%%EIe.f...I.lll?.l.Z*fN5 .......................... .. zip + 4 P ..f?.7.?..3..4. ........................... ..
b At any time during the calendar year, did the organization have an interest in or a signature or other authority
over a financial account in a foreign country (such as a bank account, securities account, or other financial Yes No
aeeeiiriil? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
If "Yes," enter the name of the foreign county P
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreing Bank
and Financial Accounts.
c At any time during the calendar year, did the organization maintain an ofhce outside ofthe U S ? , , , , , ,, ,
If "Yes," enter the name of the foreign country P
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here . . . . . . . . .. . P lj
and enter the amount of tax-exempt interest received or accrued during the tax year , , , , , ,, , P 43 I
44 Did the organization maintain any donor advised funds? lf "Yes," Form 990 must be completed instead of
No
Form 990-E2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . BIZ X
45 ls any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If
"Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . .. . 45 X
Form 990-EZ (2009)
JSA
SE1029 2 000
5
"Fprm 990-ez (2009) Page 4
.Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section
501 (c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 46-49b
and complete the tables for lines 50 and 51.
46 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to N0
candidates for public office? lf "Yes," complete Schedule C, Part l I I , , I I I , , I I , , , I I , , , , , , ,, ,
47 Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part ll , , , , I , I , , , ,, ,
48 ls the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E , , , , ,, ,
49a Did the organization make any transfers to an exempt non-charitable related organzation? , , , , I , , , ,l ,
b If "Yes," was the related organization a section 527 organzation? , , I , , , , I I , , , , , , , , , , , , , ,, ,
50 Complete this table for the organization"s five highest compensated employees (other than officers, directors, trustees and key
employees) who each received more than $100,000 of compensation from the organization If there is none, enter "None "
(b) Title and average (C) Compensation (d) Contributions to (e) Expense
(a) Name and address of each employee paid more hours per week employee benefit plans 8. account and
than $100,000 devoted to position deterred compensation other allowances
N95? ................................. -
f Total number of other employees paid over $100,000 , , , , ,, , P
51 Complete this table for the organizations five highest compensated independent contractors who each received more than
$100,000 of compensation from the organization If there is none, enter "None "
(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (C) Compensation
N95? .................................................... -
d Total number of other independent contractors receiving over $100,000 , , , ,, , P
Under penalties of perjury, l clare that l have examined this retum, including accompanying schedules and statements, and to the best of my knowledge
Here Signature of cf /3*/3
Sign Vg I-Xoticer-Date
and belie it is true, correct, d cgmplete Declaration of preparer (other than officer) is based on all infom-tation ofwhich preparer has any knowledge
eor P
TYP rintnameandtitle
, DAVE STALEY, TREASURER
I Preparers Date Check if Preparefs identifying number (See instnictions)
I $IQl1a1Llfe - Stewart LLC Em p 20-1094089
galdours i se -emed) ,Mlller &Z:I1fpIoyed,lYl
Ugzpggelcs Fiim"S?arTfe(0fIo , .
Zddrmandzigiyt P.o. Box 70, Brazil, IN 47834 p,,.,,,.,,,,,, 812-448-2551
May the lRS discuss this return with the preparer shown above? See instructions . . . . . . . . . . . . . . . . . .. . P I X lYes I INo
Form 990-EZ (zoos)
9E1031 2 000 4
JSA
Depreciation and Amortization one N0 1545-om
Form n , r
Internal Revenue Service , . An n 1
D nm mom Tr (Including Information on Listed Property)
EDB S B BBSUTY
99 P See separate instructions. P Attach to your tax return. Se?iSerri&i1No 67
Name(s) shown on return identifying number
Posey Township Volunteer Fire Depar 35-604 60 99
Business or activity to which this form relates
VAl7lWBusiness Activities
Part I Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
Maximum amount. See the instructions for a higher limit for certain businesses 250 000
Total cost of section 179 property placed in service (see instructions)
Threshold cost of section 179 property before reduction in limitation (see instructions) 800 000
Reduction in limitation Subtract line 3 from line 2 If zero or less, enter -0
Dollar limitation lor tax year Subtract line 4 from line 1 ll zero or less, enter -0- ll mamed filing separately, see instructions
(Q) Description oi property b Cost (business use onl (E) Elected cost
6
7 Listed property. Enter the amount from line 29 I 7
8 Total elected cost of section 179 property Add amounts in column (c), lines 6 and 7 8
9 Tentative deduction Enter the smaller of line 5 or line 8 9
10 Carryover of disallowed deduction from line 13 of your 2008 Form 4562 10
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11
12 Section 179 expense deduction Add lines 9 and 10, but do not enter more than line 11 12
13 Carryover of disallowed deduction to 2010 Add lines 9 and 10, less line 12 P I 13 I
Note: Donnot use Part ll or Part lll below for listed property Instead, use Part V
Partil s Special Depreciation Allowance and Other Depreciation (Do not include listed pro ertiL)-(See instructions.)
14 Special depreciation allowance for qualified property (other than listed property) placed in service dunng
the tax year (see instructions) 14
15 Property subject to section 168(i)(1) election 15
16 16
Other depreciation (including ACRS)
s Partiii MACRS Depreciation (Do not include listed propertyg)-(See instructions )
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2009 17 24 7 93
Y0 "9 9 P "Y P "9 Y 9
18 If u are electi to rou a assets laced in service dun the tax ear into one or more eneral asset accounts, check here P
Section B-Assets Placed in Service During 2009 Tax Year Using the General Depreciation System
(b) Month and (c) Basis fordepreciation (5) Recovery
(a) Classification of property year placed in (business/investment use d (e) Convention (f) Method (g) Depreciation deduction
service only-see instructions) Pano
19a
7-year property 1 087 HY
5-yearproperty 12 ,2 Q HY
3-year property
200DB
200DB
26
1,727
10-year property
15-year property
20-year property
9 25-year property .............. .. 25 yrsMM
Residential rental 27 5 yrs
S/L
Pf0P@flY 27 539 yrsMM
Nonresidential real yrs MM
h S/L
PVOPEVW MM S/L
S/L
S/L
b
C
12-year 12 yrs
20a Class life
40-year 40 yrs MM
Section C-Assets Plllaceldriun Se-rv-ice During 2008 Tax Year Using the Alternative De preciation Syste
Part tv Summary-(see instructions)
S/L
S/L
S/L
21 Listed property Enter amount from line 28 21
22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here
and on the appropriate lines of your retum Partnerships and S corporations--see instructions 22 26,546
23 For assets shown above and placed in service dunng the current year.
enter the portion of the basis attnbutable to section 263A costs 23
For Paperwork Reduction Act Notice, see separate instructions. Fomi 4562 (2009)
DAA
5
- A11 Business Activities
4797 , Sales of Business Recapture Amounts
Form" " (Also Involuntary Conversions andProperty OMB No 1545-0184
of the Treasury Attachment
Depanment99 P Attach to your tax return. P See separate instructions. Sequence No 27
Internal Revenue Service
2009
Name(s) shown on retum Identifying number
Posey Township Volunteer Fire Depar 35-6046099
1 Enter the gross proceeds from sales or exchanges reported to you for 2009 on Form(s) 1099-B or 1099-S (or substitute
statement) that you are including on line 2, 10, or 20 (see instnictions)
Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other
Than Casualty or Theft-Most Property Held More Than 1 Year (See instructions)
(e) Depreciation (1) Cost or other
of property (mo . day. yr acquired (c) sales pnce allowable allowed or basis, and (9) Gam "om me
2(a)Descnption (b) Date ) (mo , day, yr)Datesoid (d) Gross since improvements plusSubtract (0oruoss)
acquisition expense of sale sum 07 (U) and (e)
Gain, if any, from Form 4684, line 43 I
Section 1231 gain from installment sales from Form 6252, line 26 or 37
Section 1231 gain or (loss) from like-kind exchanges from Form 8824
Gain, if any, from line 32, from other than casualty or theft
Combine lines 2 through 6 Enter the gain or (loss) here and on the appropriate line as follows:
Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the
instructions for Form 1065, Schedule K, line 10, or Form 11208, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below
Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the amount
from line 7 on line 11 below and skip lines 8 and 9. lf line 7 is a gain and you did not have any prior year section
1231 losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital gain
on the Schedule D filed with your return and skip lines 8, 9, 11, and 12 below
8 Nonrecaptured net section 1231 losses from prior years (see instructions) 8
9 Subtract line 8 from line 7 If zero or less, enter -0- If line 9 is zero, enter the gain from line 7 on line 12 below.
lf line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a
9
lonq-term capital gain on the Schedule D tiled with your return (see instructions)
Paiftlll Ordinary Gains and Losses (See instructions)
10 Ordina ains and losses not included on lines 11 through 16 (include ro erty held 1 year or less
11 Loss, if any, from line 7 . 11 ( )
12
13
14
Gain, if any, from line 7 or amount from line 8, if applicable
Gain, if any, from line 31 I
Net gain or (loss) from Form 4684, lines 35 and 42a
1a 2 ,244
12
14
15 Ordinary gain from installment sales from Form 6252, line 25 or 36 15
16
17
18
Ordinary gain or (loss) from like-kind exchanges from Fom1 8824
Combine lines 10 through 16
For all except individual returns, enter the amount from line 17 on the appropnate line of your return and skip
17 2,244
16
lrnes a and b below. For individual returns, complete lines a and b below
Q-l
3 If the loss on line 11 includes a loss from Form 4684, line 39, column (b)(ii), enter that part of the loss here. Enter
b i l , , e 14 iab
the part of the loss from income-producing property on Schedule A (Form 1040), line 28, and the part of the loss
loss from property used as an employee on Schedule A (Form 1040), line 23. Identify as from "Form 4797, line
18a " See instructions
Redetermine the qain or (loss) on line 17 excludinq the loss if any, on line 18a Enter here and on Fomi 1040 lin
For Paperwork Reduction Act Notice, see separate instructions. Form 4797 (2009)
DAA
0
A11 Business Activities
Forth 47919699) ggigy ggmgm-E ygmngggg E,-Eg QQ-gag 354955929 Page 2
Part ill Gain From Disposition of Property Under Sections 1245, 1250, 1252, 1254, and 1255
(see instructions)
(b) Date acqutred (c) Date sold
19 (a) Description of section 1245, 1250, 1252, 1254, or 1255 property (mo . day. yr) (mo . day, yr)
RESCUE GEAR 10/31/02 12/07/09
RESCUE GEAR 10/31/02 11/29/09
These columns relate to the properties on lines 19A - 19D P Property A Property B Property C Property D
20 Gross sales price (Note: See line 1 before completing ) 20 1,200 1,044
21 Cost or other basis plus expense of sale 21 1,200 1,044
22 Depreclation (or depletion) allowed or allowable 22 1,200 1,044
23 Adjusted basis Subtract line 22 from line 21 23
24 Total gain Subtract line 23 from line 20 24 1.2%? 1,944
25 lf section 1245 property:
a Depreciation allowed or allowable from line 22 25a 1,200 1,044
b Enter the smaller of line 24 or 25a 25b 1.20.0 1,044
26 If section 1250 property: If straight line depreciation was used, enter
-0- on line 26g, except for a corporation subject to section 291
a Addrtional depreciatron after 1975 (see instructions) 26a
b Applicable percentage multiplied by the smaller of line 24 or
line 26a (see instructlons) 26b
c Subtract line 26a from line 24 If residential rental property or
line 24 is not more than llne 26a, skip Innes 26d and 26e 26c
Additional depreciation after 1969 and before 1976 26d
Enter the smaller of line 260 or 26d 26e
Sectron 291 amount (corporations only) 26f
Add Innes 26b, 26e, and 26f 26g
If section 1252 property: Skrp this section if you did not
dispose of farmland or if this form is belng completed for a
partnership (other than an electing large partnership)
a Soil, water, and land clearing expenses 27a
b Llne 27a multiplied by applicable percentage (see instructions) 27b
c Enter the smaller of line 24 or 27b 27c
28 If section 1254 property:
a lntanglble drilling and development costs, expendrtures for
development of mines and other natural deposits, and
mlning exploratron costs (see instructions) 28a
b Enter the smaller of line 24 or 28a 28b
29 If section 1255 property:
a Applicable percentage of payments excluded from income
under section 126 (see instructions) 29a
b Enter the smaller of line 24 or 29a (see instructlons) 29b
Summary of Part lll Gains. Complete property columns A through D through line 29b before going to line 30
30 Total gains for all properties Add property columns A through D, line 24 30 2 244
Enter here and online 13 31 2 244
31 Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b
32 Subtract line 31 from line 30 Enter the portion from casualty or theft on Form 4684, line 37 Enter the portion from
32
otherrthan casualty or theft on Form 4797, line 6
Part W Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less
(see instructions)
(a) Section (b) Section
179 280F(b)(2)
33 Section 179 expense deduction or depreciation allowable in prior years
34 Recomputed depreciation (see instructlons)
35 Recapture amount Subtract line 34 from line 33 See the instructions for where to report
DAA
Form 4797 (2009) I7
POSEY TOWNSHIP CLAY COUNTY VOLUNTEER FIRE DEPARTMENT INC
FID" 35-6046099
CALENDAR YEAR 2009
ATTACHMENT TO FORM 990-EZ
PART I, LINE 16
Bank Charges 16
Donations 84
Dues 580
l
Fuel 1,437
Insurance 11,135
Training 748
MisceIIaneous Expense 9
Repairs 8. Maintenance 6,605
Supplies 544
Office Expense 1,584
Telephone 880
Depreciation 26,546
Security System
50,425
2339 Posey Townshlp Volunteer Fare Department 08/19/2010 1 48 PM
Form 4562 Subschedules Page1
35-6046099 , Business Actlvltles
FYE1 12/3 1/2009 All
Sectlon 168(k) Class Electrons
Electron not to apply 50% first year bonus depreclatlon
MACRS
MACRS
MACRS
MACRS
MACRS
M RS 2
AC
MACRS 25-yr
MACRS 27-yr
MACRS 39-yr
Computer Soli ware ( I 67)
Pom- 33.53 Application for Extension -of Time To File an
they Apnteooot t Exempt Organization Return OMB N0 15454709
Treasury l
Department ofthe separate applicationIfor each return.
(mama) Revenue Se,-me P Flle a
0 If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box - I . . . I I , I I I , . ,I lb I X
0 If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form)
Do not complete Part ll unless you have already been granted an automatic 3-month extension on a previously hled Form 8868
M Automatic 3-Month Extension of Time. Only submit original (no copies needed).
A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete
Partlonly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..PE
Al/ other corporations (including 1120-C filers), partnerships, REM/Cs, and trusts must use Form 7004 to request an extension of
time to file income tax returns
Electronic Filing (e-file). Generally, you can electronically file Form 8868 if you want a 3-month automatic extenston of time to file
one of the returns noted below (6 months for a corporatlon required to flle Form 990-T) However, you cannot file Form 8868
electronically if (1) you want the additional (not automatic) 3-month extension or (2) you file Forms 990-BL, 6069, or 8870, group
returns, or a composlte or consolldated From 990-T Instead, you must submit the fully completed and signed page 2 (Part II) of Form
8868 For more detalls on the electronic filing of thls form, vlsit www irs gov/efi/e and click on e-fi/e for Charities & Nonprofits
Type Qr Name of Exempt Organization Employer identification number
print Posey Township Clay County Volunteer Fire Department Inc 35-604 6099
me by the Number, street, and room or sutte no If a P O box, see instructions
glue date for PQ BOX 32
rgmnyglge City, town or post office, state, and ZIP code For a foreign address, see instructions
""5""C"0"$ Staunton, IN 47881
Check type of return to be filed (file a se arate application for each return)
- Form 990 Form 990-T (corporation) Form 4720
- Form 990-BL Form 990-T (sec 401(a) or 408(a) trust) Form 5227
Form 990-Ez Form 990-T (trust other than above) Form 6069
I Form 990-PF Form 1041-A Form 8870
o The books are inthecareof P Dave 3113163/
Telephone No v 812-448-8050 FAxNo r
0 If the organization does not have an office or place of business In the Unlted States, cteck this box , , , , , , , , , , , ,, ,P E
0 If this is for a Group Return, enter theirjanizations the group, check Exemption Number (GEN) lf this
for the whole group, check this box - * If it is for part of four digit Groupthus box- - P and attach a list wlth theis
games and EIN5 Qf all members the egension wihioveg
1 I request an automatlc 3-month (6 months for a corporation required to file Form 990-T) extension of time
until August 16 , 2010 ,to file the exempt organtzatlon return for the organizatlon named above The extension is
for the organization"s return for
p calendaryear 2009 or
p I tax year beginnlng , , and endlng ,
2 If this tax year is for less than 12 months, check reason E Initial return lj Final return lj Change in accounting period
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credlts See instructions 33 $
b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments
instructions 36 5
made Include any prior year overpayment allowed as a credit 3b $
c Balance Due. Subtract line 3b from line 3a Include your payment with this form, or, if required, deposit *$55
with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See ,Qi
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO
for payment instructions
For Privacy Act and Paperwork Reduction Act Notice, see Instructions. Form 8868 (Rev 4-2009)
JSA
9F8054 2 000
Fon? ease (Rei/" +2009) 4 page 2
0 lf you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part ll and check this box , , , , , II l pI X I
Note. Only complete Part ll if you have already been granted an automatic 3-month extension on a previously filed Form 8868
Additional (Not Automatic) 3-Month Extension
0 lf iou are filing for an Automatic 3-Month Extension, complete only Part I (on of Time. (no copies needed).
Type or
Name of Exempt Organization Employer identification number
print Posey Township Clay County Volunteer Fire -604 6099
FNB bythe Number, street, and room or suite no lf a P O box, see instructions For IRS use only
"tended Po sox 32
due date for
fe Um U15
fllltns EB City, town or post office, state, and ZIP code For a foreign address, see instructions.
instructions Staunton , I N 4 7 8 8 1
Form 990 Form 990-PF Form 1041-A Form 6069
Check type of return to be filed (File a separate application for each return)"
Form 990-BL Form 990-T (sec, 401(a) or 408(a) tmst) Form 4720 Form 8870
X Form 990-EZ Form 990-T (trust other than above) Form 5227
STOPI Do not complete Part Il if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
The books are inthe care of v
8Teiepnonem. v 812-445-8050 FAxNo.P Dave Staley M
0 If the organization does not have an office or place of business in the United States, check this box . . . . . . . . . . . . .. . P III
0 lf this is for a Group Return, enter the organizations four digit Group Exemption Number (GEN) If this is
for the whole group, check this box , , , P I3 lf it is for part ofthe group, check this box , , , PI Iand attacha
list with the names and ElNs of all members the extension is for
4 I request an additional 3-month extension of time until NOVGIHDGI 15 I 20 10
5 For calendar year 200 9 , or other tax year beginning ,and ending
lfthistaxyear is for less than12 months, checkreasori I Ilnitial return I IFinal return I IChangein accounting period
Stateln detallwhyyou needthe extension Additional time is needed to gather information.
8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits See instructions I 8a S
b lf this application is for"Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated
previously with Form 8868 8b S
tax payments made Include any prior year overpayment allowed as a credit and any amount paid
c Balance Due. Subtract line 8b from line 8a. Include your payment with this form, or, if required, deposit
with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions I 8c S
Signature and Verification
Under penalties of pergury, I declare that l have examined this form, including accompanying Schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and comp te, and thatl am authonzed to prepare this form
Signature P Title P Date P Fonn 8868 (Rev 4-zoos)
JSA
QFB055 3 000
