FORM 1023-EZ for MOUNT SHALOM OUTREACH INC

Field Data
EIN 86-1688891
Case Number EO-2021102-001061
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOUNT SHALOM OUTREACH INC
Organization’s Mailing Address 2857 ANAISE COURT
City LITHONIA
State GA
ZIP 30038
Accounting period End 12
Primary contact name SEREA WILCOX
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SEREA WILCOX
PRESDIENT
2857 ANAISE COURT
LITHIONIA GA 30038

Officer/Director/Trustee Two

ZAIRE ROBINSON
TREASURER
2857 ANAISE COURT
LITHONIA GA 30038

Officer/Director/Trustee Three

JACQUELINE WILCOX
SECRETARY
2857 ANAISE COURT
LITHONIA GA 30038

Organization’s website
Organization’s email WILCOX7697@BELLSOUTH.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/28/2021
Organization Incorporation State GA
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: 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 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 SEREA WILCOX
Signature Title PRESDIENT
Signature Date 4/5/2021

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