FORM 1023-EZ for PAT & JOHNNYS SAFE HAVEN

Field Data
EIN 84-1792487
Case Number EO-2021137-000181
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PAT & JOHNNYS SAFE HAVEN
Organization’s Mailing Address 718 DANE COURT
City HEMET
State CA
ZIP 92543
Accounting period End 12
Primary contact name MARLA RANDLE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARLA RANDLE
PRESIDENT
718 DANE COURT
HEMET CA 92543

Officer/Director/Trustee Two

FLORESTEEN MILLER
TREASURER
1422 POTOMAC CIRCLE
SAN JACINTO CA 92583

Officer/Director/Trustee Three

JOHNNIESHA KEMPER
SECRETARY
718 DANE COURT
HEMET CA 92543

Organization’s website
Organization’s email MARLARANDLESHYE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/29/2021
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 MARLA RANDLE
Signature Title PRESIDENT
Signature Date 5/12/2021

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