FORM 1023-EZ for LITTLE BLUE BARN FARM

Field Data
EIN 84-4222561
Case Number EO-2021097-001083
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LITTLE BLUE BARN FARM
Organization’s Mailing Address 24403 SE TIGER MOUNTAIN RD
City ISSAQUAH
State WA
ZIP 98027
Accounting period End 12
Primary contact name ROBERT NAVARRETE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT NAVARRETE
PRESIDENT/TREASURER/DIRECTOR
24403 SE TIGER MOUNTAIN RD
ISSAQUAH WA 98027

Officer/Director/Trustee Two

KRISTINA NAVARRETE
SECRETARY/DIRECTOR
24403 SE TIGER MOUNTAIN RD
ISSAQUAH WA 98027

Officer/Director/Trustee Three

LISA OCONNELL
DIRECTOR
24329 SE TIGER MOUNTAIN RD
ISSAQUAH WA 98027

Officer/Director/Trustee Four

JUDY LEE
DIRECTOR
1810 92ND AVE NE
CLYDE HILL WA 98004

Officer/Director/Trustee Five

KAELYN ADAMS
DIRECTOR
5908 126TH AVE
BELLEVUE WA 98006

Organization’s website WWW.THELITTLEBLUEBARNSANCTUARY.COM
Organization’s email TNAV21@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/6/2020
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 ROBERT NAVARRETE
Signature Title PRESIDENT/TREASURER/DIRECTOR
Signature Date 3/15/2021

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