FORM 1023-EZ for CENTRAL COAST VETERANS SAFE HAVEN

Field Data
EIN 82-3023935
Case Number EO-2017289-000415
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CENTRAL COAST VETERANS SAFE HAVEN
Organization’s Mailing Address 912 HERBERT AVE
City LOS ANGELES
State CA
ZIP 90063
Accounting period End 12
Primary contact name RICKY PETTIFORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICKY PETTIFORD
PRESIDENT, DIRECTOR
912 HERBERT AVE
LOS ANGELES CA 90063

Officer/Director/Trustee Two

GEORGINA FLORES
TREASURER, DIRECTOR
443 S BONNIE PL
LOS ANGELES CA 90063

Officer/Director/Trustee Three

SYLVIA STEWART
SECRETARY, DIRECTOR
205 BERRYMAN ST
GREENSBORO NC 27405

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Donation of funds Yes
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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