FORM 1023-EZ for MOTHER GAIA ANIMAL RESCUE

Field Data
EIN 81-4890202
Case Number EO-2017012-000404
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MOTHER GAIA ANIMAL RESCUE
Organization’s Mailing Address PO BOX 711
City LAFAYETTE
State CO
ZIP 80026
Accounting period End 12
Primary contact name TIFFANY FOOTE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TIFFANY FOOTE
PRESIDENT, DIRECTOR
PO BOX 711
LAFAYETTE CO 80026

Officer/Director/Trustee Two

JARED KING
TREASURER, DIRECTOR
307 CATTAIL CT
LONGMONT CO 80501

Officer/Director/Trustee Three

DARBY DIGIACOMO
SECRETARY, DIRECTOR
12205 N PERRY ST STE 1
BROOMFIELD CO 80020

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/5/2017
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D99 - Animal-Related N.E.C.
Organization’s purpose Charitable: Yes
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 Yes
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 No
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
Signature Title
Signature Date

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