FORM 1023-EZ for MY BROTHERS KEEPER MBK FOUNDATION INC

Field Data
EIN 47-4705232
Case Number EO-2016012-000293
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY BROTHERS KEEPER MBK FOUNDATION INC
Organization’s Mailing Address 4755 WEHUNT TRAIL SE
City SMYRNA
State GA
ZIP 30082-7314
Accounting period End 12
Primary contact name COTY MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

COTY MARTIN
CHAIRMAN
4755 WEHUNT TRAIL SE
SMYRNA GA 30082-7314

Officer/Director/Trustee Two

DEIRIC JACKSON
VICE CHAIRMAN
12536 EUDORA LANE
CHARLOTTE NC 28277-3132

Officer/Director/Trustee Three

ROMEY BATTLE
SECRETARY
3103 EAST 27TH AVENUE
TAMPA FL 33605-1510

Officer/Director/Trustee Four

RODERICUS ROGERS
SECRETARY
6820 MAHONIA PLACE
LITHONIA, GA 30038-4591

Officer/Director/Trustee Five

LETICIA MARTIN
OFFICER
802 CONSTITUTION DRIVE UNIT C
HOMESTEAD FL 33034-3628

Organization’s website
Organization’s email MBKFOUNDATION1@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/10/2014
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 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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