FORM 1023-EZ for HAVEN 1210 ANIMAL SANCTUARY INC

Field Data
EIN 84-4478625
Case Number EO-2020062-000514
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HAVEN 1210 ANIMAL SANCTUARY INC
Organization’s Mailing Address PO BOX 526
City HOPKINSVILLE
State KY
ZIP 42241
Accounting period End 12
Primary contact name CYNTHIA J HALE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CYNTHIA HALE
PRESIDENT
150 BARNETT RD
WHITE PLAINS KY 42464

Officer/Director/Trustee Two

ELIZABETH STONE
VICE PRESIDENT
8350 LAFAYETTE RD
HOPKINSVILLE KY 42240

Officer/Director/Trustee Three

SARA BARNETT
SECRETARY
645 S MAIN ST
PEMBROKE KY 42266

Officer/Director/Trustee Four

SARAH CARSON
TREASURER
306 MERRIWOOD PKWY
HOPKINSVILLE KY 42240

Officer/Director/Trustee Five

TIMOTHY HALE
BOARD MEMBER
150 BARNETT RD
WHITE PLAINS KY 42464

Organization’s website
Organization’s email HAVEN1210SANCTUARY@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/1/2020
Organization Incorporation State KY
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 CYNTHIA HALE
Signature Title PRESIDENT
Signature Date 2/28/2020

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