FORM 1023-EZ for DOG REHABILITATION AND K-9 ASSISTEDTHERAPY CENTER INC

Field Data
EIN 85-1339398
Case Number EO-2020273-000321
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DOG REHABILITATION AND K-9 ASSISTEDTHERAPY CENTER INC
Organization’s Mailing Address 9300 CORBIN AVE
City NORTHRIDGE
State CA
ZIP 91324-2405
Accounting period End 12
Primary contact name MAXIM BASYRO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MAXIM BASYRO
CEO
9300 CORBIN AVE
NORTHRIDGE CA 91324

Officer/Director/Trustee Two

ALLEN J GOMEZ
SECRETARY
15248 CAREY RANCH IN
SYLMAR CA 91342

Officer/Director/Trustee Three

JOCELYN S CABRERA
CFO
4954 HAZELTINE AVE
SHERMAN OAKS CA 91423

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/25/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative 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 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 MAXIM BASYRO
Signature Title CEO
Signature Date 9/25/2020

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