FORM 1023-EZ for MOV ANIMAL SAFE HAVEN

Field Data
EIN 82-1100462
Case Number EO-2017100-000354
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOV ANIMAL SAFE HAVEN
Organization’s Mailing Address 202 ORCHARD DRIVE
City LITTLE HOCKING
State OH
ZIP 45742
Accounting period End 1
Primary contact name CARRIE ROE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CARRIE ROE
PRESIDENT
202 ORCHARD DRIVE
LITTLE HOCKING OH 45742

Officer/Director/Trustee Two

MICHELLE EARL
DIRECTOR
610 54TH STREET
VIENNA WV 26105

Officer/Director/Trustee Three

GABRIELLA OLSON
DIRECTOR
5500 13TH AVENUE
VIENNA WV 26105

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/7/2017
Organization Incorporation State OH
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: 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
Signature Title
Signature Date

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