FORM 1023-EZ for PLACE OF SERENITY INC

Field Data
EIN 81-2399697
Case Number EO-2017153-000287
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PLACE OF SERENITY INC
Organization’s Mailing Address PO BOX 48
City TILLSON
State NY
ZIP 12486
Accounting period End 12
Primary contact name SUSAN BRISBOIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN BRISBOIS
DIRECTOR
663 SPRINGTOWN ROAD
TILLSON NY 12486

Officer/Director/Trustee Two

PATRICIA AUSTIN
DIRECTOR
663 SPRINGTOWN ROAD
TILLSON NY 12486

Officer/Director/Trustee Three

KEITH RATHJEN
DIRECTOR
366 MT VIEW AVENUE
ULSTER PARK NY 12487

Organization’s website
Organization’s email SUSAN.BRISBOIS@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
Organization’s purpose Charitable: Yes
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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