FORM 1023-EZ for SAVE YOURSELF CDC

Field Data
EIN 81-2081585
Case Number EO-2017067-000574
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SAVE YOURSELF CDC
Organization’s Mailing Address 704 PROSPECT AVE SE APT 1
City GRAND RAPIDS
State MI
ZIP 49507
Accounting period End 12
Primary contact name MOSE STAMPS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MOSE STAMPS
PRESIDENT
704 PROSPECT AVE SE APT 1
GRAND RAPIDS MI 49507

Officer/Director/Trustee Two

TYVAN SMITH
DIRECTOR
704 PROSPECT AVE SE APT 1
GRAND RAPIDS MI 49507

Officer/Director/Trustee Three

DAMIANE LAKE
DIRECTOR
704 PROSPECT AVE SE APT 1
GRAND RAPIDS MI 49507

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/2016
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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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