FORM 1023-EZ for LITTLE MOUSE FOUNDATION

Field Data
EIN 83-4171759
Case Number EO-2020009-000258
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LITTLE MOUSE FOUNDATION
Organization’s Mailing Address 18111 BLUE RIDGE DR
City SANTA ANA
State CA
ZIP 92705
Accounting period End 12
Primary contact name SONJA KISELJAK-DUSENBURY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

NAZLY BEHNIA
DIRECTOR
1414 S SALTAIR AVE 202
LOS ANGELES CA 90025

Officer/Director/Trustee Two

KATJA KISELJAK-VASSILIADES
DIRECTOR
6546 S RIVIERA WAY
AURORA CO 80016

Officer/Director/Trustee Three

DAVID KISELJAK-DUSENBURY
TREASURER
18111 BLUE RIDGE DR
SANTA ANA CA 92705

Officer/Director/Trustee Four

SONJA KISELJAK-DUSENBURY
PRESIDENT
18111 BLUE RIDGE DR
SANTA ANA CA 92705

Organization’s website WWW.LITTLEMOUSEFOUNDATION.ORG
Organization’s email LITTLEMOUSEFOUNDATION@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2019
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q12 - Fund Raising and/or Fund Distribution
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 Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SONJA KISELJAK-DUSENBURY
Signature Title PRESIDENT
Signature Date 1/7/2020

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