FORM 1023-EZ for SAFER SPACE

Field Data
EIN 86-1830724
Case Number EO-2021091-001094
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAFER SPACE
Organization’s Mailing Address 4612 SW WATER AVE
City PORTLAND
State OR
ZIP 97239
Accounting period End 12
Primary contact name ANITA RANDOLPH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANITA RANDOLPH
DIRECTOR, PRESIDENT
4612 SW WATER AVE
PORTLAND OR 97239

Officer/Director/Trustee Two

UNIQUE PAGE
DIRECTOR, VICE PRESIDENT
4612 SW WATER AVE
PORTLAND OR 97239

Officer/Director/Trustee Three

KELLY GRACE
DIRECTOR
4612 SW WATER AVE
PORTLAND OR 97239

Officer/Director/Trustee Four

TAMMY DOWD SHEARER
DIRECTOR, SECRETARY
4612 SW WATER AVE
PORTLAND OR 97239

Officer/Director/Trustee Five

EMILY SOMERVELL
DIRECTOR, TREASURER
4612 SW WATER AVE
PORTLAND OR 97239

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/2020
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F99 - Mental Health, Crisis Intervention N.E.C.
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 Yes
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 ANITA RANDOLPH
Signature Title DIRECTOR, PRESIDENT
Signature Date 2/22/2021

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