FORM 1023-EZ for HOLLYWOOD RESCUE GROOMING INC

Field Data
EIN 47-3851594
Case Number EO-2015292-000294
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HOLLYWOOD RESCUE GROOMING INC
Organization’s Mailing Address 3807 SIERRA HWY NUM 215
City ACTON
State CA
ZIP 93510
Accounting period End 12
Primary contact name GREG MCRAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHUCK RUBIN
PRESIDENT
3807 SIERRA HWY NUM 215
ACTON CA 93150

Officer/Director/Trustee Two

DOROTHY CLINE
SECRETARY
37461 HIGHLAND CRT
PALMDALE CA 93552

Officer/Director/Trustee Three

YAEL RUBIN
TREASURER
9837 SIERRA HWY
AGUA DULCE CA 91390

Officer/Director/Trustee Four

AVI SHABAT
DIRECTOR
23352 BURBANK BLVD
WOODLAND HILLS CA 91367

Officer/Director/Trustee Five

PALOMA NEGEV
DIRECTOR
18816 MERRIDY
NORTHRIDGE CA 91136

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/8/2015
Organization Incorporation State CA
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: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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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