FORM 1023-EZ for BELLA VITA ANIMAL RESCUE INC

Field Data
EIN 84-3677997
Case Number EO-2019360-000257
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BELLA VITA ANIMAL RESCUE INC
Organization’s Mailing Address 604 HEDRICK DRIVE
City STATESVILLE
State NC
ZIP 28677
Accounting period End 12
Primary contact name LISA M VALDEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REBECCA KAMP
CHAIR/TREASURER
604 HEDRICK DR
STATESVILLE NC 28677

Officer/Director/Trustee Two

MONICA CHAPPLE
VICE CHAIR/DIRECTOR
139 SCENIC DRIVE
MOORESVILLE NC 28115

Officer/Director/Trustee Three

CARYN MCELFRESH
SECRETARY/DIRECTOR
110 BONNIE LN
STATESVILLE NC 28625

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/13/2019
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name REBECCA KAMP
Signature Title CHAIR/TREASURER
Signature Date 12/23/2019

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