FORM 1023-EZ for BREAD OF LIFE HOMELESS SHLTER INCORPORATED

Field Data
EIN 81-1680118
Case Number EO-2016259-000293
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BREAD OF LIFE HOMELESS SHLTER INCORPORATED
Organization’s Mailing Address 3723 WEST PIONEER DRIVE 1405
City IRVING TEXAS
State TX
ZIP 75061
Accounting period End 12
Primary contact name SANDRA JONES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TANYA NELSON
PRESIDENT/ DIRECTOR
3723 WEST PIONEER DRIVE
IRVING TX 75061

Officer/Director/Trustee Two

ENRIQUE PASCAL
DIRECTOR
9725 TAYLORS CROSSING COURT
GLEN ALLEN VA 23059

Officer/Director/Trustee Three

SUSIE CURTISS
DIRECTOR
1809 DARJEELING DRIVE
PFLUGERVILLE TX 78660

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/16/2016
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 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
Signature Title
Signature Date

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