FORM 1023-EZ for LEBELLA VILLA OUTREACH MINISTRY INC

Field Data
EIN 81-3556660
Case Number EO-2016251-000172
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LEBELLA VILLA OUTREACH MINISTRY INC
Organization’s Mailing Address 2618 WEST MEYER DRIVE
City MORROW
State GA
ZIP 30260
Accounting period End 12
Primary contact name DEBORAH JASPER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBORAH JASPER
EXECUTIVE DIRECTOR
2618 WEST MEYER DRIVE
MORROW GA 30260

Officer/Director/Trustee Two

CHARLENE TAYLOR
LIFE COACH
2599 BRENSTON DRIVE
ELLENWOOD GA 30294

Officer/Director/Trustee Three

WAYNE WELLS
MEDICAL DOCTOR
5962 ZEBULON ROAD
MACON GA 31210

Officer/Director/Trustee Four

TONYIA SULLIVAN
HUMAN RESOURCE SPECIALIST
1724 PENNY LANE SE
MARIETTA GA 30066

Officer/Director/Trustee Five

SYLVIA SMITH
EDUCATOR
P O BOX 770095
NEW ORLEANS LA 70117

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/2/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
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 Yes
Donation of funds Yes
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 Yes
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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