FORM 1023-EZ for ALL CREATURES SAFE HAVEN

Field Data
EIN 81-4044805
Case Number EO-2016285-000161
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ALL CREATURES SAFE HAVEN
Organization’s Mailing Address 8721 SW OTTER TRL
City PORT CHARLOTTE
State FL
ZIP 33952
Accounting period End 12
Primary contact name NICOLE OBRIEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NICOLE OBRIEN
PRESIDENT
361 LASAYETTE DR NE
PORT CHARLOTTE FL 33952

Officer/Director/Trustee Two

SHARON DYS BUCZKO
VICE PRESIDENT
12 HILLTOP AVE
FOX LAKE IL 60020

Officer/Director/Trustee Three

JENNIFER GIAMMARCO
SECRETARY
2418 FRANTZ ST
NORTH PORT FL 34286

Officer/Director/Trustee Four

ASHLEY STEVENSON
TREASURER
1031 HYDE PARK RD
LOXAHATCHEE FL 33470

Organization’s website HTTPS://WWW.FACEBOOK.COM/ALLCREATURESSAFEHAVEN
Organization’s email ALLCREATURESSAFEHAVEN@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2016
Organization Incorporation State FL
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: Yes
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
Signature Title
Signature Date

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