FORM 1023-EZ for MY CHOICE 2 CHANGE INC

Field Data
EIN 81-1594197
Case Number EO-2019259-000855
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MY CHOICE 2 CHANGE INC
Organization’s Mailing Address 1308 W ST NE
City WASHINGTON
State DC
ZIP 20018
Accounting period End 12
Primary contact name YVONNE DENISE BROCK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

BRIDGETT DIXON
OFFICIER
12402 WOODWALK TERR
MITCHELLVILLE MD 20721

Officer/Director/Trustee Two

RAPHEAL SMITH
OFFICERS
1702 GALE ST NE
WASHINGTON DC 20002

Officer/Director/Trustee Three

JENISE PATTERSON
OFFICERS
1000 MT OLIVET RD NE
WASHINGTON DC 20002

Officer/Director/Trustee Four

YVONNE BROCK
DIRECTOR
1308 W ST NE
WASHINGTON DC 20018

Organization’s website WWW.MYCHOICE2CHANGE,ORG
Organization’s email INFO@MYCHOICE2CHANGE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/19/16
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A01 - Alliance/Advocacy Organizations
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 Yes
Correctness Declaration Yes
Signature Name YVONNE BROCK
Signature Title DIRECTOR
Signature Date 9/12/19
EIN 81-1594197
Case Number EO-2017013-000447
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY CHOICE 2 CHANGE
Organization’s Mailing Address 1629 K STREET NW 300
City WASHINGTON
State DC
ZIP 20006
Accounting period End 12
Primary contact name SHARIFAH MASTEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHARIFAH MASTEN
PRESIDENT
915 CHURCH STREET 5
ALEXANDRIA VA 22314

Officer/Director/Trustee Two

YVONNE BROCK
BOARD MEMBER
1308 W STREET NE
WASHINGTON DC 20018

Officer/Director/Trustee Three

CHERMAINA ROUNDTREE
BOARD MEMBER
925 WEST OXFORD STREET
PHILADELPHIA PA 19122

Officer/Director/Trustee Four

BRUCE BRANCH
BOARD MEMBER
5897 ALLENTOWN ROAD
CAMP SPRINGS MD 20746

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/15/2016
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E30 - Health Treatment Facilities, Primarily Outpatient
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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