FORM 1023-EZ for JANE DODOLORES VALENTINE HOUSE

Field Data
EIN 87-2169414
Case Number EO-2021243-000164
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name JANE DODOLORES VALENTINE HOUSE
Organization’s Mailing Address 9535 FRANKFORT RD
City HOLLAND
State OH
ZIP 43528
Accounting period End 12
Primary contact name SHAWN VALENTINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHAWN VALENTINE
FOUNDER
9545 FRANKFORT RD
HOLLAND OH 43528

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/9/2021
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other 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 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 SHAWN VALENTINE
Signature Title FOUNDER
Signature Date 8/29/2021

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