FORM 1023-EZ for HAITIAN INSTITUTE OF ATLANTA INC

Field Data
EIN 82-2055053
Case Number EO-2017243-000262
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name HAITIAN INSTITUTE OF ATLANTA INC
Organization’s Mailing Address 846 PARK PLACE NE APT D
City CONYERS
State GA
ZIP 30012
Accounting period End 6
Primary contact name EMMANUEL BUTEAU
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EMMANUEL BUTEAU
EXECUTIVE DIRECTOR
846 PARK PLACE NE APT D
CONYERS GA 30012

Officer/Director/Trustee Two

DANIELLE BUTEAU
DIRECTOR OF OPERATIONS
846 PARK PL NE APT D
CONYERS GA 30012

Officer/Director/Trustee Three

PAUL EDOUARZIN
BOARD MEMBER
4351 MARGO STREET
AUSTELL GA 30106

Officer/Director/Trustee Four

REBEKAH BEST
BOARD MEMBER
10140 REFLECTIONS BLVD NO 202
SUNRISE FL 33351

Officer/Director/Trustee Five

LIVINGSTONE MARCELIN
BOARD MEMBER
5 EAST SECOND STREET
SEAFORD DE 19973

Organization’s website HAITIANINSTITUTE.ORG
Organization’s email INFO@HAITIANINSTITUTE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/30/2017
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
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 Yes
Donation of funds No
Conducting Activities Outside of United States Yes
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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