FORM 1023-EZ for KAYS SAFE HOUSE

Field Data
EIN 37-1699933
Case Number EO-2021096-000117
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KAYS SAFE HOUSE
Organization’s Mailing Address 10349 LETTUCE LEAF ST
City LAS VEGAS
State NV
ZIP 89183-4289
Accounting period End 12
Primary contact name KYWONA ROQUEMORE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KYWONA ROQUEMORE
FOUNDER
10349 LETTUCE LEAF ST
LAS VEGAS NV 89183-4289

Officer/Director/Trustee Two

DAKARI DAVIS
PRESIDENT
10349 LETTUCE LEAF ST
LAS VEGAS NV 89183-4289

Officer/Director/Trustee Three

KRYSTA DAVIS
TREASURER
10349 LETTUCE LEAF ST
LAS VEGAS NV 89183-4289

Officer/Director/Trustee Four

KAMILAH DAVIS
SECRETARY
10349 LETTUCE LEAF ST
LAS VEGAS NV 89183-4289

Officer/Director/Trustee Five

LAKEISHA WINSTON
BOARD MEMBER
10349 LETTUCE LEAF ST
LAS VEGAS NV 89183-4289

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/27/2020
Organization Incorporation State NV
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 KYWONA ROQUEMORE
Signature Title FOUNDER
Signature Date 3/5/2021

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