FORM 1023-EZ for TARZANS SAFE HAVEN

Field Data
EIN 81-3736280
Case Number EO-2016251-000003
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name TARZANS SAFE HAVEN
Organization’s Mailing Address 508 OPATRNY DR
City FOX RIVER GROVE
State IL
ZIP 60021
Accounting period End 12
Primary contact name DEB INZERELLO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBORAH INZERELLO
PRESIDENT
508 OPATRNY DR
FOX RIVER GROVE IL 60021

Officer/Director/Trustee Two

MICHAEL JAVID
VICE PRESIDENT
508 OPATRNY DR
FOX RIVER GROVE IL 60021

Officer/Director/Trustee Three

CORINNE BRACKO
OFFICER
5451 E ROCKY MOUNTAIN AVE
COLUMBIA MO 65201

Organization’s website
Organization’s email PURPLEBLACKMONKEY@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/1/2016
Organization Incorporation State IL
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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