FORM 1023-EZ for HEARTS OF LAVENDER INC

Field Data
EIN 84-2312207
Case Number EO-2019273-000191
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEARTS OF LAVENDER INC
Organization’s Mailing Address 2112 ADAIR STREET
City SAN MARINO
State CA
ZIP 91108
Accounting period End 12
Primary contact name SAMUEL CROWE ESQ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHYNA KIM
CEO, DIRECTOR
2112 ADAIR ST
SAN MARINO CA 91108

Officer/Director/Trustee Two

MAYUMI ONAMI
SECRETARY, CFO, DIRECTOR
2112 ADAIR ST
SAN MARINO CA 91108

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/25/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P99 - Human Services - Multipurpose and Other N.E.C.
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 SHYNA KIM
Signature Title CEO, DIRECTOR
Signature Date 9/25/19

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