FORM 1023-EZ for PIEDMONT TAX CLINIC INC

Field Data
EIN 81-4993068
Case Number EO-2017137-000291
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PIEDMONT TAX CLINIC INC
Organization’s Mailing Address 2200 SILAS CREEK PKWY STE 3A
City WINSTON SALEM
State NC
ZIP 27103
Accounting period End 12
Primary contact name LARRY LAWSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ERIK HARVEY
PRESIDENT
2200 SILAS CREEK PKWY STE 3A
WINSTON SALEM NC 27103

Officer/Director/Trustee Two

LARRY LAWSON
TREASURER
2200 SILAS CREEK PKWY STE 3A
WINSTON SALEM NC 27103

Officer/Director/Trustee Three

DAVE STARK
VICE PRESIDENT
300 N GREENE ST
GREENSBORO NC 27401

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/13/2016
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I80 - Legal Services
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 Yes
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
Signature Title
Signature Date

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