FORM 1023-EZ for LAKES AREA SAFE HARBOR

Field Data
EIN 81-5292166
Case Number EO-2017047-000175
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LAKES AREA SAFE HARBOR
Organization’s Mailing Address 534 W COMMERCE RD
City COMMERCE TWP
State MI
ZIP 48382
Accounting period End 12
Primary contact name KELLY JANECZEK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WENDY COX
PRESIDENT, DIRECTOR
260 LAKE VILLAGE DR
WALLED LAKE MI 48390

Officer/Director/Trustee Two

DEVON BURNLEY
SECRETARY, DIRECTOR
1586 HUNTERS RIDGE DR
BLOOMFIELD MI 48304

Officer/Director/Trustee Three

KELLY JANECZEK
TREASURER, DIRECTOR
9980 BURGESS CT
WHITE LAKE MI 48386

Officer/Director/Trustee Four

JILL NUHN
DIRECTOR
534 W COMMERCE RD
COMMERCE TWP MI 48382

Officer/Director/Trustee Five

MIKE STACK
DIRECTOR
701 LAGUNA
WOLVERINE LAKE MI 48390

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/7/2017
Organization Incorporation State MI
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: Yes
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
Signature Title
Signature Date

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