FORM 1023-EZ for SIELER SAFEHAVEN FOUNDATION

Field Data
EIN 87-2771273
Case Number EO-2021267-000399
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SIELER SAFEHAVEN FOUNDATION
Organization’s Mailing Address 12620 20TH STREET EAST
City PARRISH
State FL
ZIP 34219
Accounting period End 12
Primary contact name RANDY SIELER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ZACHARY SIELER
PRESIDENT
100 PEARL ROAD
LAKE PLACID FL 33852

Officer/Director/Trustee Two

RANDY SIELER
BOARD MEMBER
10634 MICHAEL BLVD
PINCKNEY MI 48169

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/22/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T22 - Private Independent Foundations
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 RANDY SIELER
Signature Title BOARD MEMBER
Signature Date 9/22/2021

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