FORM 1023-EZ for VANDERBEAK SAFE HAVEN INCORPORATED

Field Data
EIN 47-1967417
Case Number EO-2016272-000252
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VANDERBEAK SAFE HAVEN INCORPORATED
Organization’s Mailing Address 3040 NORTH ROADRUNNER DRIVE
City ELOY
State AZ
ZIP 85131
Accounting period End 9
Primary contact name FELICE LARSEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FELICE LARSEN
PRESIDENT
7832 EAST CORONADO ROAD
SCOTTSDALE AZ 85257

Officer/Director/Trustee Two

TERRY MCGILL
DIRECTOR
5333 SOUTH MILL AVENUE
TEMPE AZ 85283

Organization’s website HTTP://WWW.VANDERBEAK.ORG
Organization’s email VALERIEVANDERBEAK@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/25/2014
Organization Incorporation State AZ
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D31 - Protection of Endangered Species
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 No
One Third Support Gifts Yes
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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