FORM 1023-EZ for AUTISM WITH PASSION

Field Data
EIN 81-3057248
Case Number EO-2016243-000134
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AUTISM WITH PASSION
Organization’s Mailing Address 6849 SHOUP AVE
City WEST HILLS
State CA
ZIP 91307
Accounting period End 12
Primary contact name MARY DANIEL GOSSETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY GOSSETT
PRESIDENT
2849 SHOUP AVE
WEST HILLS CA 91307

Officer/Director/Trustee Two

ANTHONY JANZ
TRESURER
2849 SHOUP AVE
WEST HILLS CA 91307

Officer/Director/Trustee Three

SAMANTA SARMIENTO
SECRETARY
6857 SHOUP AVE
WEST HILLS CA 91307

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/1/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B28 - Specialized Education Institutions
Organization’s purpose Charitable: Yes
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 No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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