FORM 1023-EZ for TINAS HOME FOR ANGELS INC

Field Data
EIN 82-2241814
Case Number EO-2017275-000606
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TINAS HOME FOR ANGELS INC
Organization’s Mailing Address 4020 DAVID DRIVE
City NORTH HIGHLANDS
State CA
ZIP 95660
Accounting period End 12
Primary contact name WILLIAM CONVERSE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TINA AVILA
PRESIDENT
4020 DAVID DRIVE
NORTH HIGHLANDS CA 95660

Officer/Director/Trustee Two

DANIEL CONVERSE
TREASURER
11865 COBBLE BROOK DR
RANCHO CORDOVA CA 95742-8008

Officer/Director/Trustee Three

KRISTA BUNTING
SECRETARY
7677 PLAID CIRCLE
ANTELOPE CA 95843

Officer/Director/Trustee Four

MIKE VANDER DUSSEN
DIRECTOR
7551 CALAWAY DR
RANCHO MURIETA CA 95683

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P72 - Half-Way House (Short-Term Residential Care)
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 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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