FORM 1023-EZ for SIMON SEZ

Field Data
EIN 83-4706029
Case Number EO-2019133-000588
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SIMON SEZ
Organization’s Mailing Address 12132 COUNTRY SIDE DRIVE
City HARTLAND
State MI
ZIP 48353
Accounting period End 12
Primary contact name MELISSA GLAZER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA GLAZER
OWNER
12132 COUNTRY SIDE SRIVE
HARTLAND MI 48353

Officer/Director/Trustee Two

PATRICIA BASH
TRUSTEE
2210 N DUCK LAKE ROAD
HIGHLAND MI 48356

Officer/Director/Trustee Three

MATTHEW FOWLER
TRUSTEE
5236 JON PAUL
WHITE LAKE MI 48383

Organization’s website
Organization’s email BREAKAWAY@AOL.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/18
Organization Incorporation State MI
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MELISSA GLAZER
Signature Title OWNER
Signature Date 5/10/19

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