FORM 1023-EZ for CLIFFORD HOUSE

Field Data
EIN 11-3822445
Case Number EO-2016120-000164
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLIFFORD HOUSE
Organization’s Mailing Address 1216 MOUNT OLIVET RD NE
City WASHINGTON
State DC
ZIP 20002
Accounting period End 4
Primary contact name ANTHONY BELL SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ANTHONY BELL SR
PRESIDENT
2624 AFTON ST
TEMPELL HILLS MD 20748

Officer/Director/Trustee Two

DARRELL HARDIE
CHAIRMAN OF THE BOARD
11400 RIVERVIEW RD
FT WASHINGTON MD 20744

Officer/Director/Trustee Three

ANTHONY BELL JR
VICE PRESIDENT
2624 AFTON ST
TEMPLE HILLS MD 20748

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2011
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F33 - Group Home, Residential Treatment Facility - Mental Health Related
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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