FORM 1023-EZ for EMPOWERED COMMUNITY SERVICES

Field Data
EIN 84-5164881
Case Number EO-2021187-000455
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EMPOWERED COMMUNITY SERVICES
Organization’s Mailing Address 2487 LANCASTER DRIVE NE
City SALEM
State OR
ZIP 97305
Accounting period End 3
Primary contact name TINA LARSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

APRIL ONEILL
PRESIDENT
222 JUNEVA PL SE
SCIO OR 97317

Officer/Director/Trustee Two

TINA LARSEN
TREASURER
36854 GILKEY ROAD
SCIO OR 97374

Officer/Director/Trustee Three

COURTNEY LARSEN
SECRETARY
36850 GILKEY ROAD
SCIO OR 97374

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
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 No
Correctness Declaration Yes
Signature Name APRIL ONEILL
Signature Title PRESIDENT
Signature Date 7/2/2021

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