FORM 1023-EZ for MALLORYS MIRACLE CHILDRENS CHARITY

Field Data
EIN 81-3896081
Case Number EO-2016266-000166
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MALLORYS MIRACLE CHILDRENS CHARITY
Organization’s Mailing Address PO BOX 205
City BURNS
State TN
ZIP 37029
Accounting period End 12
Primary contact name LAWSON GREEN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LAWSON GREEN
PRESIDENT
1006 MEADOWOOD LN
DICKSON TN 37055

Officer/Director/Trustee Two

JOHNNY CLARK
VICE-PRESIDENT
PO BOX 1045
DICKSON TN 37056

Officer/Director/Trustee Three

TAMMY KILGORE
TREASURER
226 BRADY DR
DICKSON TN 37055

Officer/Director/Trustee Four

MARLETTA LILLY
SECRETARY
916 YATES RD
WHITE BLUFF TN 37187

Organization’s website MIRACLE4MALLORY@YAHOO.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/20/2016
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E80 - Health, General and Financing
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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