FORM 1023-EZ for SHEAS SAFE HAVEN INC

Field Data
EIN 83-1917096
Case Number EO-2018267-000333
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHEAS SAFE HAVEN INC
Organization’s Mailing Address C/O WEINBERG 90 STATE ST SUITE 815
City ALBANY
State NY
ZIP 12207
Accounting period End 12
Primary contact name JOAN GRAHAM
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLARA IACOPELLI
DIRECTOR
441 HILLSIDE AVENUE
WEST SAYVILLE NY 11796

Officer/Director/Trustee Two

KELLY ANN BERWICK
DIRECTOR
120A LINCOLN ROAD
MEDFORD NY 11763

Officer/Director/Trustee Three

DR TARA TROYAN DVM
DIRECTOR
444 WEST MAIN STREET
PATCHOGUE NY 11772

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/27/18
Organization Incorporation State NY
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: 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 CLARA IACOPELLI
Signature Title DIRECTOR
Signature Date 9/21/18

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