FORM 1023-EZ for MISSION INDEPENDENCE

Field Data
EIN 82-4350056
Case Number EO-2018079-000298
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MISSION INDEPENDENCE
Organization’s Mailing Address 34658 CAMINO CAPISTRANO
City CAPISTRANO BEACH
State CA
ZIP 92624-1333
Accounting period End 12
Primary contact name AYESHAH MORIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AYESHAH MORIN
PRESIDENT
34658 CAMINO CAPISTRANO
CAPISTRANO BEACH CA 92624-1333

Officer/Director/Trustee Two

CODY COLLIER
SECRETARY
34658 CAMINO CAPISTRANO
CAPISTRANO BEACH CA 92624-1333

Officer/Director/Trustee Three

MARTIN DEKARVER
TREASURER
34658 CAMINO CAPISTRANO
CAPISTRANO BEACH CA 92624-1333

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/13/17
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P82 - Developmentally Disabled Centers, Services
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 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 AYESHAH MORIN
Signature Title PRESIDENT
Signature Date 3/18/18

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