FORM 1023-EZ for LOVE MY REFLECTION

Field Data
EIN 81-1846934
Case Number EO-2017110-000199
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LOVE MY REFLECTION
Organization’s Mailing Address 15646 SE UPMAN WAY
City DAMASCUS
State OR
ZIP 97089
Accounting period End 12
Primary contact name ANNIE BURN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ADRIANN BURN
PRESIDENT
15646 SE UPMAN WAY
DAMASCUS OR 97089

Officer/Director/Trustee Two

CHRISTINA QUIRINO
SECRETARY
14331 SE SEIBEN PKWY
CLACKAMAS OR 97015

Officer/Director/Trustee Three

AVERY BURN
YOUTH ADVISORY BOARD PRESIDENT
15646 SE UPMAN WAY
DAMASCUS OR 97089

Organization’s website WWW.LOVEMYREFLECTION.ORG
Organization’s email INFO@LOVEMYREFLECTION.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/30/2015
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N01 - Alliance/Advocacy Organizations
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 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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