FORM 1023-EZ for AGENT CHANGE

Field Data
EIN 84-2126785
Case Number EO-2019182-000736
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AGENT CHANGE
Organization’s Mailing Address 835 RAVINE TERRACE DR
City ROCHESTER HILLS
State MI
ZIP 48307
Accounting period End 12
Primary contact name ANASTASIA SAHU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANANDI SAHU
DR.
835 RAVINE TERRACE DR
ROCHESTER HILLS MI 48307

Officer/Director/Trustee Two

EKATERINA ESSINA
MRS.
835 RAVINE TERRACE DR
ROCHESTER HILLS MI 48307

Officer/Director/Trustee Three

ANASTASIA SAHU
PRESIDENT/FOUNDER
835 RAVINE TERRACE DR
ROCHESTER HILLS MI 48307

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/19
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E60 - Health Support Services
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 ANASTASIA SAHU
Signature Title PRESIDENT/FOUNDER
Signature Date 6/29/19

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