FORM 1023-EZ for CLEANSTART INC

Field Data
EIN 81-2179550
Case Number EO-2016104-000197
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEANSTART INC
Organization’s Mailing Address 615 GEORGETOWN PLACE
City DAVIS
State CA
ZIP 95616-1821
Accounting period End 12
Primary contact name GARY SIMON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

GARY SIMON
CHAIRMAN
615 GEORGETOWN PLACE
DAVIS CA 95616-1821

Officer/Director/Trustee Two

MONIQUE BROWN
SECRETARY-TREASURER
909 MORMON STREET
FOLSOM CA 95630

Officer/Director/Trustee Three

KEN BOSSUNG
DIRECTOR
909 MORMON STREET
FOLSOM CA 95630

Organization’s website WWW.CLEANSTART.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/5/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W70 - Leadership Development
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 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
Signature Title
Signature Date

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