FORM 1023-EZ for POSITIVE YOUTH AND FAMILY DEVELOPMENT SERVICES - NEW NAME CHANGE

Field Data
EIN 26-4493591
Case Number EO-2018074-000116
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name POSITIVE YOUTH AND FAMILY DEVELOPMENT SERVICES - NEW NAME CHANGE
Organization’s Mailing Address 9476 LAKEWIND LANE-NEW ADDRESS
City ELK GROVE
State CA
ZIP 95758
Accounting period End 12
Primary contact name MICHELLE PERKINS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MICHELLE PERKINS
EXECUTIVE DIRECTOR
9476 LAKEWIND LANE
ELK GROVE CA 95758

Officer/Director/Trustee Two

CHARMAINE UELIGATONE
BOARD MEMBER
1805 ROCKROSE ROAD
W.SACRAMENTO CA 95691

Officer/Director/Trustee Three

WILLIAM JOHNSON
BOARD MEMBER
4340 STOCKTON BLVD
SACRAMENTO CA 95820

Officer/Director/Trustee Four

ANTHONY NEWTON
BOARD MEMBER
8516 MIDDLESAX WAY
SACRAMENTO CA 95828

Officer/Director/Trustee Five

GREG SMITH
BOARD MEMBER
5637 NORTH PERSHING AVENUE STE H8A
STOCKTON CA 95207

Organization’s website
Organization’s email PYFDS.CA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/12/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
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 Yes
Correctness Declaration Yes
Signature Name MICHELLE PERKINS
Signature Title CEO
Signature Date 3/12/18

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