FORM 1023-EZ for FAMILY SURVIVOR NETWORK

Field Data
EIN 82-5324129
Case Number EO-2018120-000693
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY SURVIVOR NETWORK
Organization’s Mailing Address 218 E LEXINGTON STREET SUITE 505
City BALTIMORE
State MD
ZIP 21202
Accounting period End 12
Primary contact name CORNIELUS SCOTT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CORNIELUS SCOTT
PRESIDENT
218 E LEXINGTON STREET
BALTIMORE MD 21202

Officer/Director/Trustee Two

SHYMAINE DAVIS
TREASURER
3527 N ROLLING ROAD SUITE 21
BALTIMORE MD 21244

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/1/18
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 SHYMAINE DAVIS
Signature Title TREASURER
Signature Date 4/27/18

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