FORM 1023-EZ for SOUL SURVIVOR SOBER LIVING HOME ASSOCIATION

Field Data
EIN 84-3521292
Case Number EO-2019331-000340
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SOUL SURVIVOR SOBER LIVING HOME ASSOCIATION
Organization’s Mailing Address 3612 OAK GROVE DR
City MIDWEST CITY
State OK
ZIP 73110
Accounting period End 12
Primary contact name ELIZABETH CAMPHOR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ELLA JEFFERSON-SPEED
PRESIDENT
6804 GREEN MEADOW LN
OKLAHOMA CITY OK 73132

Officer/Director/Trustee Two

NET HETEP TANESERT
SECRETARY
11339 N MAY AVE
OKLAHOMA CITY OK 73120

Officer/Director/Trustee Three

TIFFANY IMKE
TREASURER
2508 ASHLEY DR
OKLAHOMA CITY OK 73120

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/16/19
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L99 - Housing, Shelter N.E.C.
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 ELLA JEFFERSON-SPEED
Signature Title PRESIDENT
Signature Date 11/25/19

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