FORM 1023-EZ for ROOM TO ROAM

Field Data
EIN 20-1582470
Case Number EO-2016161-000234
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROOM TO ROAM
Organization’s Mailing Address 1705 BROMPTON STREET
City PETALUMA
State CA
ZIP 94954-8581
Accounting period End 12
Primary contact name LARRY MODELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LARRY MODELL
PRESIDENT
1705 BROMPTON ST
PETALUMA CA 94954-8581

Officer/Director/Trustee Two

DAVID LIBCHITZ
TREASURER
333-B WILSON ST
PETALUMA CA 94952

Officer/Director/Trustee Three

BRUCE HAGEN
SECRETARY
145 GREVILLIA
PETALUMA CA 94952

Officer/Director/Trustee Four

GERALD PRICE
DIRECTOR
737 SOUTHPOINT BLVD SUITE L
PETALUMA CA 94954

Organization’s website HTTP://WWW.LAFFERTYRANCH.ORG/ROOMROAM
Organization’s email LARRYMOD@COMCAST.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/18/2004
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code C01 - Alliance/Advocacy Organizations
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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