FORM 1023-EZ for SHATTERED LIVES OF MONTGOMERY COUNTY

Field Data
EIN 16-1696857
Case Number EO-2016326-000352
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHATTERED LIVES OF MONTGOMERY COUNTY
Organization’s Mailing Address P O BOX 2863
City CONROE
State TX
ZIP 77305-2863
Accounting period End 5
Primary contact name ELAINE BUTLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHAEL VALDEZ
PRESIDENT
203 SIMONTON STREET
CONROE TX 77301-2863

Officer/Director/Trustee Two

DEBI JO FELDER
VICE PRESIDENT
2221 HIGH POINT MEADOW
CONROE TX 77304

Officer/Director/Trustee Three

ELAINE BUTLER
SECRETARY
29534 USONIA
SPRING TX 77386-4325

Officer/Director/Trustee Four

BRENNA JASZKOWIAK
TREASURER
31835 FOREST OAK LANE
CONROE TX 77385-5127

Organization’s website SHATTEREDLIVESMC.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/2004
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
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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