FORM 1023-EZ for CAREGIVER SAFE PLACE INC

Field Data
EIN 84-1989640
Case Number EO-2019170-000178
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAREGIVER SAFE PLACE INC
Organization’s Mailing Address 25399 THE OLD RD APT 17103
City STEVENSON RANCH
State CA
ZIP 91381
Accounting period End 12
Primary contact name CARLETTA COLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARLETTA COLE
DIRECTOR
25399 THE OLD RD APT 17103
STEVENSON RANCH CA 91381

Officer/Director/Trustee Two

KIA RIDDICK-TAYLOR
DIRECTOR
4700 CAPITAL BLVD ST
CLOUD FL 34769

Officer/Director/Trustee Three

STEPHANIE CHRISTIE
DIRECTOR
3015 MIDDLESEX RD
ORLANDO FL 32803

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/23/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 Yes
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 CARLETTA COLE
Signature Title DIRECTOR
Signature Date 6/17/19

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