SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
SELBY VOLUNTEER AMBULANCE SERVICE
 
Employer identification number

46-0413472
Return Reference Explanation
FORM 990-EZ, PART I, LINE 16 EXPENSES OFFICE SUPPLIES 1,885 TRAVEL & MEALS 600 INSURANCE 5,050 TAXES & LICENSES 207 MEDICAL SUPPLIES 7,675 GIFTS 6,298 REPAIRS AND MAINTENANCE 511 NON-INVESTMENT DEPRECIATION 26,771 TOTAL 48,997
FORM 990-EZ, PART II, LINE 24 189,347 189,347 LESS ACCUMULATED DEPRECIATION 18,566 45,337 TOTAL 170,781 144,010
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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