FORM 1023-EZ for CONCRETE ROSE TLM

Field Data
EIN 86-2824996
Case Number EO-2021148-000556
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CONCRETE ROSE TLM
Organization’s Mailing Address 4629 VITRINA LANE
City PALMDALE
State CA
ZIP 93551
Accounting period End 4
Primary contact name TIYANA MORRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIYANA MORRIS
PRES & PROGRAM DIR
4629 VITRINA LANE
PALMDALE CA 93551

Officer/Director/Trustee Two

SIDNEY MORRIS
SECRETARY
4629 VITRINA LANE
PALMDALE CA 93551

Officer/Director/Trustee Three

GENEVIEVE GLASS
TREASURER
6717 SYLVIA AVENUE
RESEDA CA 91335

Officer/Director/Trustee Four

YOLANDA GLASS
ART DIRECTOR
13733 BURBANK BOULEVARD APT 206
VAN NUYS CA 91401

Officer/Director/Trustee Five

JACKIE MANQUEILN
FAMILY OUTREACH PROG DIR
42657 8TH ST EAST
LANCASTER CA 93535

Organization’s website
Organization’s email CONCRETEROSETLM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/29/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity Yes
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 TIYANA MORRIS
Signature Title PRES & PROGRAM DIR
Signature Date 5/26/2021

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