FORM 1023-EZ for CANOPY YOUNG ADULT COMMUNITY HOUSE

Field Data
EIN 84-2972756
Case Number EO-2019259-000528
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CANOPY YOUNG ADULT COMMUNITY HOUSE
Organization’s Mailing Address 540 W THIRD ST
City LEXINGTON
State KY
ZIP 40508-1241
Accounting period End 12
Primary contact name BEAU RANDALL REVLETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BEAU REVLETT
PRESIDENT
117 IRVING LANE
GEORGETOWN KY 40324-2094

Officer/Director/Trustee Two

ALEXIS LANE
SECRETARY
521 S BROADWAY APT 2226A
LEXINGTON KY 40508-2991

Officer/Director/Trustee Three

KAITLYN FRICK
TREASURER
105 BURLEY AVE
LEXINGTON KY 40503-1007

Organization’s website
Organization’s email CANOPYCOMMUNITYHOUSE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/8/19
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P85 - Homeless Persons Centers, Services
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 Yes
Donation of funds Yes
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 BEAU REVLETT
Signature Title PRESIDENT
Signature Date 9/11/19

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