FORM 1023-EZ for ACTIV8HER INC

Field Data
EIN 83-1921984
Case Number EO-2018262-000298
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ACTIV8HER INC
Organization’s Mailing Address PO BOX 1224
City MEXICO
State NY
ZIP 13114
Accounting period End 12
Primary contact name CHRISTINE GARRETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHRISTINE GARRETT
DIRECTOR OF ADMINISTRATION
6633 STATE ROUTE 3
MEXICO NY 13114

Officer/Director/Trustee Two

KOLLEEN LUCARIELLO
DIRECTOR OF COMMUNICATION & CONTENT
53 WOODVIEW DRIVE
PARISH NY 13131

Officer/Director/Trustee Three

ROBERT GENANT ESQ
BOARD MEMBER
3306 MAIN STREET
MEXICO NY 13114

Organization’s website WWW.ACTIV8HER.ORG
Organization’s email ACTIV8HERNOW@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/31/18
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CHRISTINE GARRETT
Signature Title DIRECTOR OF ADMINISTRATION
Signature Date 9/17/18

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