FORM 1023-EZ for CAMELLIA CITY MARKET INC

Field Data
EIN 81-3417664
Case Number EO-2016340-000223
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CAMELLIA CITY MARKET INC
Organization’s Mailing Address 153 MOONRAKER DR
City SLIDELL
State LA
ZIP 70458
Accounting period End 6
Primary contact name DALE MOORE CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

REGINA DUBUISSON
DIRECTOR
153 MOONRAKER DR
SLIDELL LA 70458

Officer/Director/Trustee Two

MICHAEL MCKENDALL
DIRECTOR
5035 WEST ST ANDREWS CIRCLE
NEW ORLEANS LA 70125

Officer/Director/Trustee Three

ERIC CALVIN
DIRECTOR
64217 VIRGINA DR
PEARL RIVER LA 70452

Officer/Director/Trustee Four

LAURA GARRITY
DIRECTOR
4126 WALNUT ST
SLIDELL LA 70461

Officer/Director/Trustee Five

CLARENCE ROGERS
DIRECTOR
4126 WALNUT ST
SLIDELL LA 70461

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/9/2016
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K99 - Food, Agriculture, and Nutrition N.E.C.
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 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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