FORM 1023-EZ for EMPIRE SMILE

Field Data
EIN 83-1941686
Case Number EO-2019070-000313
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name EMPIRE SMILE
Organization’s Mailing Address 5901 BROOKLYN BLVD STE 208
City BROOKLYN BLVD
State MN
ZIP 55445
Accounting period End 12
Primary contact name LOVETH AMAYANVBO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LOVETH AMAYANVBO
ADMINISTRATOR
6813 90TH AVE N
BROOKLYN PARK MN 55445

Officer/Director/Trustee Two

DICKSON ALIGBE
FOUNDING EXECUTIVE
6813 90TH AVE N
BROOKLYN PARK MN 55445

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/14/18
Organization Incorporation State MN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A20 - Arts, Cultural Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 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 LOVETH AMAYANVBO
Signature Title ADMINISTRATOR
Signature Date 3/8/19

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