FORM 1023-EZ for PLACE OF PURPOSE

Field Data
EIN 83-3469350
Case Number EO-2019039-001003
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PLACE OF PURPOSE
Organization’s Mailing Address 109 MARTIN LUTHER KING DR
City AHOSKIE
State NC
ZIP 27910
Accounting period End 11
Primary contact name CANDANCE MEBANE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CANDANCE REYNOLDS MEBANE
CEO
150 CHOANOKE INDIAN TRL
WINTON NC 27986-9512

Officer/Director/Trustee Two

LETRICE FUTRELL
CFO
PO BOX 144
KELFORD NC 27847

Officer/Director/Trustee Three

SHAQUITTA MURRAY
COO
109 TROY FUTRELL RD
AULANDER NC 27805

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P80 - Services to Promote the Independence of Specific Populations
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 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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CANDANCE REYNOLDS MEBANE
Signature Title CEO
Signature Date 2/6/19

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