FORM 1023-EZ for CHI OMICRON ZETA CHARITABLE FUND

Field Data
EIN 81-0888235
Case Number EO-2015358-000161
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHI OMICRON ZETA CHARITABLE FUND
Organization’s Mailing Address 3663 GATEWAY DRIVE APT 1B
City PORTSMOUTH
State VA
ZIP 23703
Accounting period End 12
Primary contact name SHAVONNE PERRY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHAVONNE E PERRY
PRESIDENT
3663 GATEWAY DR APT 1B
PORTSMOUTH VA 23703

Officer/Director/Trustee Two

CHANEL ALFORD-CAMPBELL
VICE PRESIDENT
1061 GAS LIGHT LN
VIRGINIA BEACH VA 23462

Officer/Director/Trustee Three

MARIAN V BARNWELL
DIRECTOR
2005 WHITE WATER DR
VIRGINIA BEACH VA 23456

Officer/Director/Trustee Four

ERICA WARDEN
SECRETARY
621 GLOUCESTER DR
NEWPORT NEWS VA 23605

Officer/Director/Trustee Five

ANAYA CHANDLER
TREASURER
524 HADLEYBROOK DR
CHESAPEAKE VA 23320

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/22/2015
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
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 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
Signature Title
Signature Date

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