FORM 1023-EZ for BLAKES BRIGADE AUTISM AND VETERAN SERVICE DOGS

Field Data
EIN 83-3825927
Case Number EO-2019066-000378
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLAKES BRIGADE AUTISM AND VETERAN SERVICE DOGS
Organization’s Mailing Address 58250 SW HEBO RD
City LONGVIEW
State OR
ZIP 98632
Accounting period End 12
Primary contact name MICHELLE MUSSO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE MUSSO
OFFICER
2511 ASPEN DR
LONGVIEW WA 98632

Officer/Director/Trustee Two

PATRICIA FULLER
OFFICER
58250 SW HEBO RD
GRAND RONDE OR 97347

Organization’s website
Organization’s email BLAKESBRIGADE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/22/19
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 MICHELLE MUSSO
Signature Title OFFICER
Signature Date 3/5/19

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