FORM 1023-EZ for ENVISION HAVEN INC

Field Data
EIN 84-4782296
Case Number EO-2020136-000285
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ENVISION HAVEN INC
Organization’s Mailing Address 124 EAST BOOKER AVENUE
City WYANDANCH
State NY
ZIP 11798
Accounting period End 12
Primary contact name DONNA R DREW
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SONOVIA ROBERTS
PRESIDENT
126 DAVIDSON STREET
WYANDANCH NY 11798

Officer/Director/Trustee Two

KEVIN JOSEY
TREASURER
535 BEACH 43 STREET
FAR ROCKAWAY NY 11691

Officer/Director/Trustee Three

DONNA DREW
SECRETARY
21 MERCER STREET
SOUTH RIVER NJ 08882

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/10/2020
Organization Incorporation State NY
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: 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 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 SONOVIA ROBERTS
Signature Title PRESIDENT
Signature Date 5/13/2020

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