FORM 1023-EZ for SENIORSAFE INC

Field Data
EIN 83-1407291
Case Number EO-2018220-000289
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SENIORSAFE INC
Organization’s Mailing Address 1326 W NORTH BLVD ST 4
City LEESBURG
State FL
ZIP 34748
Accounting period End 7
Primary contact name DAVID O WILKENS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID O WILKINS
EXECUTIVE DIRECTOR
1326 W NORTH BLVD ST 4
LEESBURG FL 34748

Officer/Director/Trustee Two

KATINA PANTAZIS
DIRECTOR
13710 N US HWY 441 ST 500
THE VILLAGES FL 32159

Officer/Director/Trustee Three

KEVIN BRANCH
DIRECTOR
13940 N US HWY 441 ST 802
THE VILLAGES FL 32159

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/1/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R25 - Seniors' Rights
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 DAVID O WILKINS
Signature Title EXECUTIVE DIRECTOR
Signature Date 8/6/18

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