FORM 1023-EZ for POWER HOUSE SOBER LIVING CORPORATION

Field Data
EIN 82-4614218
Case Number EO-2018292-000341
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POWER HOUSE SOBER LIVING CORPORATION
Organization’s Mailing Address 210 E IVY AVE 5
City INGLEWOOD
State CA
ZIP 90302
Accounting period End 12
Primary contact name PAUL JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DR CHARLOTTE PETTY
CEO
210 E IVY AVE 1
INGLEWOOD CA 90302

Officer/Director/Trustee Two

PAUL JONES
VICE PRESIDENT
210 E IVY AVE 1
INGLEWOOD CA 90302

Officer/Director/Trustee Three

RON WEEKLY
SECRETARY
610 6TH AVE 102
VENICE CA 90291

Officer/Director/Trustee Four

DR CHARLOTTE PETTY
CFO
210 E IVY AVE 1
INGLEWOOD CA 90302

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/30/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B19 - Nonmonetary Support N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 Yes
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 DR CHARLOTTE PETTY
Signature Title CEO
Signature Date 10/17/18

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