FORM 1023-EZ for ASSISTED LIVING FACILITY IS HEAVENLY INC

Field Data
EIN 82-0951872
Case Number EO-2017095-000209
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ASSISTED LIVING FACILITY IS HEAVENLY INC
Organization’s Mailing Address 1709 BLOSSOM CIRCLE WEST
City LAKELAND
State FL
ZIP 33805-2670
Accounting period End 12
Primary contact name SYLVIA MORRIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SYLVIA MORRIS
CEO/PRESIDENT
1709 BLOSSOM CIRCLE WEST
LAKELAND FL 33805-2670

Officer/Director/Trustee Two

ERMA MORRIS
DIRECTOR
1709 BLOSSOM CIRCLE WEST
LAKELAND FL 33805-2670

Officer/Director/Trustee Three

DEONIS JERNIGAN
DIRECTOR
669 NE ANNIE MATTOX STREET
LAKE CITY FL 32055-2329

Officer/Director/Trustee Four

JULIA WRIGHT
DIRECTOR
13912 NOBLE PARK DRIVE
TAMAPA FL 33556

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/6/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: Yes
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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