FORM 1023-EZ for SURVIVORS FOR RESEARCH INC

Field Data
EIN 81-1873210
Case Number EO-2016187-000292
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SURVIVORS FOR RESEARCH INC
Organization’s Mailing Address PO BOX 358584
City GAINSEVILLE
State FL
ZIP 32635
Accounting period End 12
Primary contact name DAVID S MILLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THERESA WEBER
DIRECTOR AND PRESIDENT
4516 NW 36TH TERRACE
GAINSEVILLE FL 32605

Officer/Director/Trustee Two

BARBARA THOMAS
DIRECTOR, VICE PRESIDENT, TREASURER
3422 NW 27TH PLACE
GAINESVILLE FL 32605

Officer/Director/Trustee Three

WALTER ODELL
DIRECTOR
251 STAR LAKE DRIVE
HAWTHORNE FL 32640

Officer/Director/Trustee Four

CHERI S KNECHT
DIRECTOR AND SECRETARY
6826 NW 77TH STREET
GAINESVILLE FL 32653

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/14/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G32 - Breast Cancer
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 Yes
One Third Support Gifts No
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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