FORM 1023-EZ for CHATSWORTH SAFE ACCESS

Field Data
EIN 81-4527933
Case Number EO-2016343-000323
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHATSWORTH SAFE ACCESS
Organization’s Mailing Address 1625 VALLEY HIGH AVE
City THOUSAND OAKS
State CA
ZIP 91362
Accounting period End 12
Primary contact name MICHAEL MATHIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL MATHIS
CHAIRMAN, CEO
1625 VALLEY HIGH AVE
THOUSAND OAKS CA 91362

Officer/Director/Trustee Two

DAVID SPRIGGS
TREASURER, SECRETARY
1010 E OAKEY BLVD
LAS VEGAS NV 89104

Organization’s website NA
Organization’s email NA@NA.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E01 - Alliance/Advocacy Organizations
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 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
Signature Title
Signature Date

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