FORM 1023-EZ for PEACEFUL HAVEN INC

Field Data
EIN 27-5447719
Case Number EO-2016291-000270
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PEACEFUL HAVEN INC
Organization’s Mailing Address 11005 TULIP HILL LANE
City UPPER MARLBORO
State MD
ZIP 20772
Accounting period End 12
Primary contact name LATONJA MARTIN PHD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LATONJA MARTIN PHD
DIRECTOR
11005 TULIP HILL LANE
UPPER MARLBORO MD 20772

Officer/Director/Trustee Two

CHARLOTTA GLASS
DIRECTOR
7410 PINEY BRANCH ROAD
TAKOMA PARK MD 20912

Officer/Director/Trustee Three

DEVRON ELLIOTT
DIRECTOR
1509 POTOMAC HEIGHTS DRIVE
FORT WASHINGTON MD 20744

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/21/2011
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F33 - Group Home, Residential Treatment Facility - Mental Health Related
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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