FORM 1023-EZ for CLEAN SLATE RESCUE AND REHABILITATION INC

Field Data
EIN 47-4391050
Case Number EO-2015183-000194
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEAN SLATE RESCUE AND REHABILITATION INC
Organization’s Mailing Address 23101 SLIDELL ROAD
City BOYDS
State MD
ZIP 20841-9339
Accounting period End 12
Primary contact name MARIA ANSELMO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARIA ANSELMO
PRESIDENT
23101 SLIDELL ROAD
BOYDS MD 20841-9339

Officer/Director/Trustee Two

RITA ANSELMO
TREASURER
23101 SLIDELL ROAD
BOYDS MD 20841-9339

Officer/Director/Trustee Three

JANICE HAZLEHURST
SECRETARY
6403 CAMROSE TER
BETHESDA MD 20817-1609

Officer/Director/Trustee Four

LEAH CHIAVERINI
VICE PRESIDENT
7005 RAINSWOOD COURT
BETHESDA MD 20817-2231

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/2015
Organization Incorporation State MD
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: No
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 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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