FORM 1023-EZ for YOUR SAFE HAVENN INC

Field Data
EIN 84-3736957
Case Number EO-2020027-000440
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name YOUR SAFE HAVENN INC
Organization’s Mailing Address PO BOX 2383
City STONE MOUNTAIN
State GA
ZIP 30086
Accounting period End 12
Primary contact name KEINOSHA KEATON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KEINOSHA KEATON
PRESIDENT
PO BOX 2383
STONE MOUNTAIN GA 30086

Officer/Director/Trustee Two

MACIO EDMONDS III
VICE PRESIDENT
PO BOX 2383
STONE MOUNTAIN GA 30086

Officer/Director/Trustee Three

COURTNEY DIRTON
DIRECTOR
PO BOX 2383
STONE MOUNTAIN GA 30086

Organization’s website
Organization’s email YOURSAFEHAVENN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 KEINOSHA KEATON
Signature Title PRESIDENT
Signature Date 1/24/2020

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