FORM 1023-EZ for RISE HAITI INC

Field Data
EIN 82-3419633
Case Number EO-2017321-000373
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RISE HAITI INC
Organization’s Mailing Address 755 LANCASTER AVENUE
City ORANGE CITY
State FL
ZIP 32763
Accounting period End 12
Primary contact name KELLY A ERNEST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KELLY ERNEST
PRESIDENT
755 LANCASTER AVENUE
ORANGE CITY FL 32763

Officer/Director/Trustee Two

FARRAH ERNEST
DIRECTOR
755 LANCASTER AVENUE
ORANGE CITY FL 32763

Officer/Director/Trustee Three

JOHN ERNEST
DIRECTOR
115 EAST CYPRESS AVENUE
HOWEY IN THE HILLS FL 34737

Officer/Director/Trustee Four

BRENDA WALLACE
DIRECTOR
552 SOUTH PINE MEADOW DRIVE
DEBARY FL 32713

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/15/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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
Signature Title
Signature Date

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