FORM 1023-EZ for ACTIVE LIFESTYLE INC

Field Data
EIN 81-2636842
Case Number EO-2017123-000234
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ACTIVE LIFESTYLE INC
Organization’s Mailing Address 56 JAMES ROIAD
City AMERICAN CANYON
State CA
ZIP 94503
Accounting period End 5
Primary contact name GORDON KEISER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GORDON KEISER
FOUNDER
56 JAMES RD SUITE 11
AMERICAN CANYON CA 94503

Officer/Director/Trustee Two

MICHAEL TURRINI
SECRETARY
205 ALVARDO
VALLEJO CA 94590

Officer/Director/Trustee Three

MARK LAMPKIN
TREASURER
1315 ROLLINGWOOD
VALLEJO CA 94591

Organization’s website WWW.ACTIVELIFESTYLEINC.COM
Organization’s email GORDON@ACTIVELIFESTYLEINC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/18/2016
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
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 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
Signature Title
Signature Date

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