FORM 1023-EZ for DINING SAFETY ALLIANCE

Field Data
EIN 82-0673423
Case Number EO-2017080-000158
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DINING SAFETY ALLIANCE
Organization’s Mailing Address 155 E BOARDWALK DR 471
City FORT COLLINS
State CO
ZIP 80525
Accounting period End 12
Primary contact name HARLAN STUEVEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HARLAN STUEVEN
EXECUTIVE DIRECTOR
25730 HICKORY BLVD 536
BONITA SPRINGS FL 34134

Officer/Director/Trustee Two

GERALD STUEVEN
DIRECTOR
2313 S YANK ST
LAKEWOOD CO 80228

Officer/Director/Trustee Three

BARBARA ROBERTS
DIRECTOR
200 DOLPHIN POINT UNIT 102
CLEARWATER BEACH FL 33767

Officer/Director/Trustee Four

JAMES MATEER
DIRECTOR
1096 N POINTVIEW ROAD
OCONOMOWOC WI 53066

Officer/Director/Trustee Five

JIM LOPOLITO
DIRECTOR
31 JUPITER DRIVE
MONROE NY 10950

Organization’s website DININGSAFETYALLIANCE.ORG
Organization’s email DRSTUEVEN@DININGSAFETYALLIANCE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/27/2017
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code M01 - Alliance/Advocacy Organizations
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 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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