FORM 1023-EZ for SAFE HOME HOUSING

Field Data
EIN 81-1187639
Case Number EO-2016047-000058
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAFE HOME HOUSING
Organization’s Mailing Address 790 VANDAL WAY
City PALMDALE
State CA
ZIP 93551
Accounting period End 12
Primary contact name REV DR BELVA JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MICHAEL JOHNSON
PRESIDENT
790 VANDAL WAY
PALMDALE CA 93551

Officer/Director/Trustee Two

JUANITA MC WILLIAMS
VICE PRESIDENT
38121 25TH STREET EAST
PALMDALE CA 93550

Officer/Director/Trustee Three

REV DR BELVA JOHNSON
SECRETARY
790 VANDAL WAY
PALMDALE CA 93551

Officer/Director/Trustee Four

ELENORA WILLIAMS
TREASURER
239 EAST AVENUE R4
PALMDALE CA 93550

Officer/Director/Trustee Five

DENISE HARRELL-MCMILLON
DIRECTOR
37008 NORTHVIEW COURT
PALMDALE CA 93550

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/4/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L99 - Housing, Shelter N.E.C.
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 Yes
Donation of funds Yes
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 Yes
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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