FORM 1023-EZ for RESPITEONE

Field Data
EIN 81-3850010
Case Number EO-2016347-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RESPITEONE
Organization’s Mailing Address 915 NE 175TH AVE
City PORTLAND
State OR
ZIP 97230
Accounting period End 12
Primary contact name ROBERT LAMBERT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT LAMBERT
PRESIDENT
915 NE 175TH AVE
PORTLAND OR 97230

Officer/Director/Trustee Two

ANASTASIA JONES
SECRETARY/TREASURER
9703 NE 26TH
VANCOVER WA 98665

Officer/Director/Trustee Three

CHARLETTE WEST
DIRECTOR
5922 N ATLANTIC AVE
PORTLAND OR 97217

Organization’s website RESPITEONE.COM
Organization’s email INFO@RESPITEONE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/30/2016
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
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
Signature Title
Signature Date

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