FORM 1023-EZ for MITYANA COMMUNITY PARTNERSHIP

Field Data
EIN 83-3293200
Case Number EO-2019038-001004
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MITYANA COMMUNITY PARTNERSHIP
Organization’s Mailing Address 1527 5TH AVE
City SAN RAFAEL
State CA
ZIP 94901
Accounting period End 12
Primary contact name LAWRENCE S SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SUSAN E BROMANN-SMITH
CEO/EXECUTIVE DIRECTOR
1527 5TH AVE
SAN RAFAEL CA 94901

Officer/Director/Trustee Two

LAWRENCE S SMITH
TREASURER
1527 5TH AVE
SAN RAFAEL CA 94901

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/11/19
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Q19 - Nonmonetary Support N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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 LAWRENCE S SMITH
Signature Title TREASURER
Signature Date 1/25/19

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