FORM 1023-EZ for DRIVER REHABILITATION INSTITUTE INC

Field Data
EIN 84-2116219
Case Number EO-2019177-000392
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DRIVER REHABILITATION INSTITUTE INC
Organization’s Mailing Address 816 OLIVE STREET
City PETALUMA
State CA
ZIP 94952
Accounting period End 12
Primary contact name DARYL REESE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MIRIAM MONAHAN
DIRECTOR/PRESIDENT
816 OLIVE ST
PETALUMA CA 94952

Officer/Director/Trustee Two

THOMAS MONAHAN
DIRECTOR/SECRETARY/TREASURER
816 OLIVE ST
PETALUMA CA 94952

Officer/Director/Trustee Three

BARBARA WINTERS
DIRECTOR
816 OLIVE ST
PETALUMA CA 94952

Officer/Director/Trustee Four

ELIZABETH TOLMIE
DIRECTOR
816 OLIVE ST
PETALUMA CA 94952

Officer/Director/Trustee Five

DENISE WATSON
DIRECTOR
816 OLIVE ST
PETALUMA CA 94952

Organization’s website DRIVERREHABINSTITUTE.ORG
Organization’s email JAY@DRIVERREHABINSTITUTE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E50 - Rehabilitative Medical Services
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 Yes
Donation of funds No
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 MIRIAM MONAHAN
Signature Title DIRECTOR/PRESIDENT
Signature Date 6/24/19

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