FORM 1023-EZ for PELEESE SIVA FOUNDATIION

Field Data
EIN 45-4576060
Case Number EO-2019098-000336
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PELEESE SIVA FOUNDATIION
Organization’s Mailing Address 1055 S 317TH ST
City FEDERAL WAY
State WA
ZIP 98003
Accounting period End 12
Primary contact name FALEFITUOA ROBERTSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

FALEFITUOA ROBERTSON
DIRECTOR
1055 S 317TH ST
FEDERAL WAY WA 98003

Officer/Director/Trustee Two

ANOIMALO MAUIA
VICE CHAIR
4950 SW 319TH LANE J201
FEDERAL WAY WA 98023

Officer/Director/Trustee Three

MATAIMOANA SEUMAE
SECRETARY
2457 S SPENCER ST
SEATTLE WA 98108

Officer/Director/Trustee Four

BELINA BYARS
TREASURER
1055 S 317TH ST
FEDERAL WAY WA 98003

Organization’s website WWW.PELEESESIVAFOUNDATION.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/18
Organization Incorporation State WA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 FALEFITUOA ROBERTSON
Signature Title DIRECTOR
Signature Date 4/5/19

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