FORM 1023-EZ for DISTURB THE SILENCE INC

Field Data
EIN 82-0940586
Case Number EO-2017090-000367
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DISTURB THE SILENCE INC
Organization’s Mailing Address 2401 SECOND STREET NW APT 43
City WINTER HAVEN
State FL
ZIP 33881
Accounting period End 12
Primary contact name MICHELE BOUIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELE BOUIE
PRESIDENT
P O BOX 3064
LAKE WALES FL 33859

Officer/Director/Trustee Two

SHIRLEY PELLARCHY
DIRECTOR
490 US-17
BARTOW FL 33830

Officer/Director/Trustee Three

BRANDI ANCRUM
SECRETARY
680 EAST MAIN STREET SUITE 101
BARTOW FL 33830

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/22/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F70 - Mental Health Disorders
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 Yes
One Third Support Gifts No
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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