FORM 1023-EZ for A MOMENT TO BREATHE

Field Data
EIN 83-1451003
Case Number EO-2018218-000627
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A MOMENT TO BREATHE
Organization’s Mailing Address 18421 SANDRINGHAM CT
City PORTER RANCH
State CA
ZIP 91326
Accounting period End 12
Primary contact name STACEY COHEN-MAITRE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

STACEY COHEN-MAITRE
PRESIDENT
18421 SANDRINGHAM CT
PORTER RANCH CA 91326

Officer/Director/Trustee Two

TAMMY BRANDT
SECRETARY
18421 SANDRINGHAM CT
PORTER RANCH CA 91326

Officer/Director/Trustee Three

LETICIA WOODARD
TREASURER
18421 SANDRINGHAM CT
PORTER RANCH CA 91326

Officer/Director/Trustee Four

RITA EAGLE
DIRECTOR
18421 SANDRINGHAM CT
PORTER RANCH CA 91326

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/27/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 STACEY COHEN-MAITRE
Signature Title PRESIDENT
Signature Date 8/3/18

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