FORM 1023-EZ for SAFE HAVEN LGBTQ INC

Field Data
EIN 86-3481801
Case Number EO-2021152-000842
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAFE HAVEN LGBTQ INC
Organization’s Mailing Address 404 MILLARD ST APT 7
City SCHENECTADY
State NY
ZIP 12307
Accounting period End 4
Primary contact name LEGACY CASANOVA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AUSHAWNA DIXON
DIRECTOR
404 MILLARD ST APT 7
SCHENECTADY NY 12307

Officer/Director/Trustee Two

STAR MIZZERO
TRUSTEE
404 MILLARD ST APT 7
SCHENECTADY NY 12307

Officer/Director/Trustee Three

LONDON JAE
OFFICER
136 GRAND ST
ALBANY NY 12305

Officer/Director/Trustee Four

LEGACY CASANOVA
OFFICER
404 MILLARD ST APT 7
SCHENECTADY NY 12307

Organization’s website WWW.SAFEHAVENLGBTQINC.COM
Organization’s email SAFEHAVENLGBTQ2021@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/21/2021
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P88 - LGBTQ Centers
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 AUSHAWNA DIXON
Signature Title DIRECTOR
Signature Date 5/29/2021

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