FORM 1023-EZ for LIFE SIX FOUNDATION

Field Data
EIN 47-2134237
Case Number EO-2014297-000653
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE SIX FOUNDATION
Organization’s Mailing Address 400 CAPITAL CIR STE 18148
City TALLAHASSEE
State FL
ZIP 32301
Accounting period End 12
Primary contact name MOSES DEGRAFT-JOHNSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MOSES DEGRAFT-JOHNSON
MANAGING DIRECTOR
400 CAPITAL CIR STE 18148
TALLAHASSEE FL 32301

Officer/Director/Trustee Two

JEFFREY DEGRAFT-JOHNSON
EXECUTIVE DIRECTOR
400 CAPITAL CIR STE 18148
TALLAHASSEE FL 32301

Organization’s website PENDING
Organization’s email MDJOHNSON@LIFESIX.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/20/2014
Organization Incorporation State DE
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
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 Yes
Donation of funds Yes
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 Yes
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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