FORM 1023-EZ for SAFE HAVEN PET RESCUE INC

Field Data
EIN 46-3742047
Case Number EO-2015008-000195
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAFE HAVEN PET RESCUE INC
Organization’s Mailing Address 8041 BERMUDA POINT LANE
City DAVIE
State FL
ZIP 33328
Accounting period End 12
Primary contact name TONY WALLACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

EWA WALLACE
PRESIDENT
8041 BERMUDA POINT LANE
DAVIE FL 33328

Officer/Director/Trustee Two

TONY WALLACE
TREASURER
8041 BERMUDA POINT LANE
DAVIE FL 33328

Officer/Director/Trustee Three

YVONNE CIESIELSKA
SECRETARY
8041 BERMUDA POINT LANE
DAVIE FL 33328

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/23/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
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 No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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