FORM 1023-EZ for RESTORED AND REVIVED

Field Data
EIN 83-2488929
Case Number EO-2018324-000026
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name RESTORED AND REVIVED
Organization’s Mailing Address 509 NW 83RD ST
City VANCOUVER
State WA
ZIP 98665
Accounting period End 12
Primary contact name PATRICIA L JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAHNEA PHILLIPS
PRESIDENT
509 NW 83RD ST
VANCOUVER WA 98665

Officer/Director/Trustee Two

LORI YOUNG
SECTRETARY-TREASURER
509 NW 83RD ST
VANCOUVER WA 98665

Officer/Director/Trustee Three

MYCHAL LECOURIS
VICE PRESIDENT
509 NW 83RD ST
VANCOUVER WA 98665

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/9/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P62 - Victims' Services
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 JAHNEA PHILLIPS
Signature Title PRESIDENT
Signature Date 11/16/18

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