FORM 1023-EZ for SURVIVOR SUPPORT INCORPORATED

Field Data
EIN 82-4388286
Case Number EO-2018045-000258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SURVIVOR SUPPORT INCORPORATED
Organization’s Mailing Address 969 COLSON WAY
City GALT
State CA
ZIP 95632
Accounting period End 12
Primary contact name JON K UHLER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JON UHLER
PRESIDENT, CEO,
969 COLSON WAY
GALT CA 95632

Officer/Director/Trustee Two

SUSAN SKROCKI
DIRECTOR
969 COLSON WAY
GALT CA 95632

Organization’s website SURVIVORSUPPORT.NET
Organization’s email JON@SURVIVORSUPPOORT.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/12/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I73 - Sexual Abuse, Prevention of
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 JON UHLER
Signature Title PRESIDENT, CEO,
Signature Date 2/12/18

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