FORM 1023-EZ for LIFE CHANGERS INTERNATIONAL MINISTRIES

Field Data
EIN 35-2561144
Case Number EO-2016147-000222
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE CHANGERS INTERNATIONAL MINISTRIES
Organization’s Mailing Address 187 COUNTRY SKIRE LANE
City JACKSONVILLE
State FL
ZIP 28540
Accounting period End 12
Primary contact name YULONDA T GRIFFIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JOE KIRK JR
PRESIDENT; DIRECTOR
187 COUNTRY SKIRE LANE
JACKSONVILLE FL 28540

Officer/Director/Trustee Two

TACOMA ANDERSON
CFO
4675 WENDELL BLVD
WENDELL NC 27591

Officer/Director/Trustee Three

CASSANDRA ROSE
VICE PRESIDENT
4121A JUNIPER LANE
WILSON NC 27896

Officer/Director/Trustee Four

SHONDA KIRK
SECRETARY, DIRECTOR
187 COUNTRY SKIRE LANE
JACKSONVILLE FL 28540

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/3/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 Yes
Conducting Activities Outside of United States Yes
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
Signature Title
Signature Date

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