FORM 1023-EZ for SAFE HAVEN OUTREACH CENTER

Field Data
EIN 64-0872988
Case Number EO-2018058-000247
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SAFE HAVEN OUTREACH CENTER
Organization’s Mailing Address 329 S MAIN STREET
City PICAYUNE
State MS
ZIP 39466
Accounting period End 4
Primary contact name ROSE GRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FREDERICK GRAY
DIRECTOR
1520 S GRADY AVENUE
PICAYUNE MS 39466

Officer/Director/Trustee Two

BRIDGET GRAY
SECRETARY
168 B SCOTT FARM RD
POPLARVILLE MS 39470

Officer/Director/Trustee Three

ROSE GRAY
TREASURE
1520 S GRADY AVENUE
PICAYUNE MS 39466

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/96
Organization Incorporation State MS
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P60 - Emergency Assistance (Food, Clothing, Cash)
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance Yes
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROSE GRAY
Signature Title TREASURE
Signature Date 2/25/18

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