FORM 1023-EZ for S E R V A EMPOWERMENT INC

Field Data
EIN 84-5003547
Case Number EO-2020087-000206
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name S E R V A EMPOWERMENT INC
Organization’s Mailing Address 3768 EISENHOWER PARKWAY
City MACON
State GA
ZIP 31206
Accounting period End 12
Primary contact name JANET LAMAR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JARVIS BRICE
TREASURER
130 OAKMEADOWS PLACE
COVINGTON GA 30016

Officer/Director/Trustee Two

TABITHA HOGAN
SECRETARY
137 BRAXTON DR
MACON GA 31210

Officer/Director/Trustee Three

TERESA SIMMONS
ASST SECRETARY
2655 VINVILLE AVE APT J
MACON GA 31204

Officer/Director/Trustee Four

JANET LAMAR
DIRECTOR
P O BOX 7053
WARNER ROBINS GA 31095

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/11/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
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 JANET LAMAR
Signature Title DIRECTOR
Signature Date 3/25/2020

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