FORM 1023-EZ for SENIOR MOMENTS INC

Field Data
EIN 37-1853213
Case Number EO-2017093-000417
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SENIOR MOMENTS INC
Organization’s Mailing Address 1927 WEST 136TH STREET
City COMPTON
State CA
ZIP 90222-3111
Accounting period End 12
Primary contact name GINELL BUTLER CEO-PRESIDENT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GINELL BUTLER
CEO PRESIDENT
1927 WEST 136TH STREET
COMPTON CA 90222-3111

Officer/Director/Trustee Two

GAIL BUTLER
COO
1443 EAST 139TH STREET
ROSEWOOD CA 90222-3111

Officer/Director/Trustee Three

SANDRA PAGE
CHAIRPERSON-SECRETARY
8021 SUNDANCE LANE
LA PALMA CA 90623-2112

Officer/Director/Trustee Four

VALIERE SAMUEL
CFO
11133 TRENTON COURT
RANCHO CUCAMONGA CA 91701-5368

Organization’s website N/A
Organization’s email GINELLBUTLER@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/13/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code V36 - Gerontology (as a social science)
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
Signature Title
Signature Date

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