FORM 1023-EZ for SMASH SELF-DEFENSE

Field Data
EIN 82-3860405
Case Number EO-2018051-000263
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SMASH SELF-DEFENSE
Organization’s Mailing Address 122 2ND AVENUE
City NEW YORK
State NY
ZIP 10003
Accounting period End 12
Primary contact name SANDRA SHAMBURGER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SANDRA SHAMBURGER
BOARD MEMBER
310 W 128TH ST
NEW YORK NY 10027

Officer/Director/Trustee Two

JANE RAY
BOARD MEMBER
125 EAST 4TH STREET
NEW YORK NY 10003

Officer/Director/Trustee Three

NATHANAEL BARBAY
BOARD MEMBER
2078 PARK DRIVE
LOVELAND CO 80538

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/27/17
Organization Incorporation State NY
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: 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 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 SANDRA SHAMBURGER
Signature Title BOARD MEMBER
Signature Date 2/16/18

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