FORM 1023-EZ for SENIOR MOMENTS PET HOSPICE

Field Data
EIN 84-2473074
Case Number EO-2019207-000194
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SENIOR MOMENTS PET HOSPICE
Organization’s Mailing Address 24700 KEENE COURT
City TEHACHAPI
State CA
ZIP 93561
Accounting period End 12
Primary contact name ASHLEY LACKEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ASHLEY LACKEY
PRESIDENT
24700 KEENE CT
TEHACHAPI CA 93561

Officer/Director/Trustee Two

KENZO LACKEY
SECRETARY, TREASURER
24700 KEENE CT
TEHACHAPI CA 93561

Organization’s website N/A
Organization’s email SENIORMOMENTSPETS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/7/19
Organization Incorporation State CA
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: 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 ASHLEY LACKEY
Signature Title PRESIDENT
Signature Date 7/24/19

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