FORM 1023-EZ for HAVEN OF REST MINISTRY INC

Field Data
EIN 47-1527749
Case Number EO-2014240-000597
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HAVEN OF REST MINISTRY INC
Organization’s Mailing Address 1100 PRALEY ST
City VALDESE
State NC
ZIP 28690
Accounting period End 12
Primary contact name A TODD CARSWELL CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CLYDE ADAMS
PRESIDENT
2602 CONNOR CIRCLE
LENOIR NC 28645

Officer/Director/Trustee Two

KEVIN CRAWFORD
SECRETARY
400 MAPLEWOOD LANE
MORGANTON NC 28655

Officer/Director/Trustee Three

TOM CHURCH
VICE PRESIDENT
2589 RALPH L ROAD
HICKORY NC 28602

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/2014
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
One Third Support Gifts Yes
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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