FORM 1023-EZ for CLEAN LIFE CLEAN HOME FOUNDATION

Field Data
EIN 82-0644221
Case Number EO-2017261-000161
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEAN LIFE CLEAN HOME FOUNDATION
Organization’s Mailing Address 1407 KANSAS STREET
City NORMAN
State OK
ZIP 73069
Accounting period End 12
Primary contact name JIM FORGOTSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MELISSA JOHNSON
PRESIDENT/FOUNDER
1407 KANSAS STREET
NORMAN OK 73069

Officer/Director/Trustee Two

OLIVIA HERRERA
DIRECTOR
4405 INTREPID CIRCLE
NORMAN OK 73072

Officer/Director/Trustee Three

LISA LEWIS
ASSISTANT DIRECTOR
2021 ALAMEDA STREET APT 910
NORMAN OK 73071

Officer/Director/Trustee Four

MORGAN HEITT
ASSISTANT DIRECTOR
10700 SOUTH MAY AVE APT 1121
OKLAHOMA CITY OK 73159

Officer/Director/Trustee Five

ERIN EDELMAN
TRUSTEE
420 BARBOUR STREET
NORMAN OK 73069

Organization’s website CLEANLIFECLEANHOME.COM
Organization’s email CLEANLIFECLEANHOME@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/12/2016
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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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