FORM 1023-EZ for CLEMONTS FAMILY FOUNDATION INC

Field Data
EIN 83-1581949
Case Number EO-2018254-000075
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CLEMONTS FAMILY FOUNDATION INC
Organization’s Mailing Address 1339 CEDAR ROCK RD
City WOODBURY
State GA
ZIP 30293
Accounting period End 12
Primary contact name JOSEPH CLEMONTS JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSEPH CLEMONTS JR
PRESIDENT
520 12 STREET S APT 1428
ARLINGTON VA 22202

Officer/Director/Trustee Two

JACQUELINE CLEMONTS
VICE PRESIDENT
1339 CEDAR ROCK RD
WOODBURY GA 30293

Officer/Director/Trustee Three

PETRINA JARRETT
TREASURER
805 ASKEW AVE APT A
HOGANVILLE GA 30222

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/14/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 JOSEPH CLEMONTS JR
Signature Title PRESIDENT
Signature Date 9/7/18

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