FORM 1023-EZ for A FAMILY STORY

Field Data
EIN 81-3197096
Case Number EO-2016208-000451
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name A FAMILY STORY
Organization’s Mailing Address 18615 COACHMANS TRACE
City CORNELIUS
State NC
ZIP 28031
Accounting period End 12
Primary contact name JASON CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JASON CLARK
CHAIR
18615 COACHMANS TRACE
CORNELIUS NC 28031

Officer/Director/Trustee Two

MARK APPLEYARD
VICE CHAIR
8206 STOURHEAD GARDENS LANE
WAXHAW NC 28173

Officer/Director/Trustee Three

SCOTT CROWDER
SECRETARY
7 WAGNER CIRCLE
NEWPORT NEWS VA 23602

Officer/Director/Trustee Four

SHAWN RING
TREASURER
3808 SANDLIN STREET
SOUTH LAKE TX 76092

Organization’s website HTTP://WWW.AFAMILYSTORY.ORG/
Organization’s email JASONLCLARKIS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/15/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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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