FORM 1023-EZ for REVIVE HAITI INC

Field Data
EIN 46-3646644
Case Number EO-2016312-000373
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name REVIVE HAITI INC
Organization’s Mailing Address 53 NW 106 ST
City MIAMI
State FM
ZIP 33150
Accounting period End 12
Primary contact name SUNJA LEON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANA BURKE LEON
PRESIDENT
780 NE 69 ST
MIAMI FL 33138

Officer/Director/Trustee Two

KATIA PHILIPPEAUX
VICE PRESIDENT
12500 SW 5TH CT APT M110
MIAMI FL 33027

Officer/Director/Trustee Three

MICHELLE BENJAMIN
SECRETERY
1316 EAST 35 ST
BALTIMORE MD 21218

Officer/Director/Trustee Four

SUNJA LEON
DIRECTOR
53 NW 106 ST
MIAMI FL 33150

Organization’s website WWW.REVIVEHAITI.ORG
Organization’s email REVIVEHAITIINC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/9/2013
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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