FORM 1023-EZ for CICELYS HOUSE II

Field Data
EIN 83-1016906
Case Number EO-2018190-000395
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CICELYS HOUSE II
Organization’s Mailing Address 9728 FAIRES FARM ROAD
City CHARLOTTE
State NC
ZIP 28213
Accounting period End 12
Primary contact name CICELY SLAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CICELY SLAY
EXECUTIVE DIRECTOR
9728 FAIRES FARM ROAD
CHARLOTTE NC 28213

Officer/Director/Trustee Two

JOHN MCCOY
PRESIDENT
9728 FAIRES FARM ROAD
CHARLOTTE NC 28213

Officer/Director/Trustee Three

SHAWN STOWE
SECRETARY
9728 FAIRES FARM ROAD
CHARLOTTE NC 28213

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/5/18
Organization Incorporation State NC
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: Yes
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 CICELY SLAY
Signature Title EXECUTIVE DIRECTOR
Signature Date 7/5/18

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