FORM 1023-EZ for FAMILY IMPACT FOR LIFE

Field Data
EIN 47-3769797
Case Number EO-2019050-000457
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY IMPACT FOR LIFE
Organization’s Mailing Address 29315 CINNAMON WOOD WAY
City MENIFEE
State CA
ZIP 92584
Accounting period End 12
Primary contact name DEBRA PATRICE WELLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBRA PATRICE WELLS
CHIEF EXECUTIVE DIRECTOR
29315 CINNAMON WOOD WAY
MENIFEE CA 92584

Officer/Director/Trustee Two

TININA PETTWAY
SCRETARY
41770 MARGARITA ROAD 1094
TEMECULA CA 92591

Officer/Director/Trustee Three

DEVAORAL RIVAS
TREASURER
34819 HERITAGE OAK COURT
WINCHESTER CA 92596

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
Organization’s purpose Charitable: No
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 DEBRA PATRICE WELLS
Signature Title CHIEF EXECUTIVE DIRECTOR
Signature Date 2/15/19

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