FORM 1023-EZ for FULL CIRCLE OF LIVING AND DYING

Field Data
EIN 83-1909460
Case Number EO-2018264-000222
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FULL CIRCLE OF LIVING AND DYING
Organization’s Mailing Address 347 HORIZON CIRCLE
City GRASS VALLEY
State CA
ZIP 95945
Accounting period End 12
Primary contact name DONNA PEIZER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AKHILA MURPHY
DIRECTOR
11202 OAK CANYON DRIVE
PENN VALLEY CA 95946

Officer/Director/Trustee Two

NANDI SZABO
DIRECTOR
12214 PALOMA WAY
GRASS VALLEY CA 95945

Officer/Director/Trustee Three

CMA MEDEIROS
DIRECTOR
12636 GREENFIELDS WAY
GRASS VALLEY CA 95945

Officer/Director/Trustee Four

DONNA PEIZER
DIRECTOR
347 HORIZON CIRCLE
GRASS VALLEY CA 95945

Officer/Director/Trustee Five

MARTHA TURNER
DIRECTOR
10860 DOLORES DRIVE
GRASS VALLEY CA 95945

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B01 - Alliance/Advocacy Organizations
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 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 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 DONNA PEIZER
Signature Title DIRECTOR
Signature Date 9/19/18

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