FORM 1023-EZ for THE BROKEN BIRD INC

Field Data
EIN 46-5210102
Case Number EO-2019031-000589
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name THE BROKEN BIRD INC
Organization’s Mailing Address 5024 MANDURIA STREET
City ORLANDO
State FL
ZIP 32812
Accounting period End 12
Primary contact name CLARA GRAVES-HOPKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLARA GRAVES-HOPKINS
P/D
5024 MANDURIA ST
ORLANDO FL 32812

Officer/Director/Trustee Two

DEBRA JACKSON
S/D
29 CORSAIR CIR
PORT WENTWORTH GA 31407

Officer/Director/Trustee Three

SELENIA ORTIZ
T/D
1105 LYNRIDGE LN NE
PALM BAY FL 32907

Organization’s website
Organization’s email BROKENBIRDINC@OUTLOOK.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/14
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
Organization’s purpose Charitable: No
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 Yes
Correctness Declaration Yes
Signature Name CLARA GRAVES-HOPKINS
Signature Title P/D
Signature Date 1/4/19

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