FORM 1023-EZ for STAT OF NORTH CAROLINA INC

Field Data
EIN 45-2463989
Case Number EO-2015086-000457
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name STAT OF NORTH CAROLINA INC
Organization’s Mailing Address P O BOX 2434
City SHALLOTE
State NC
ZIP 28459
Accounting period End 12
Primary contact name ALLYSA MCKENZIE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ALLYSA MCKENZIE
PRESIDENT
1799 SANDALWOOD DR
OCEAN ISLE BEACH NC 28469

Officer/Director/Trustee Two

NADINE AUGSTINE
SECRETARY
112 FIREHOUSE RD
POCONO PINES PA 18350

Officer/Director/Trustee Three

ALYSSA EARNHEART
VICE PRESIDENT
1082 JONATHAN CREEK
WAYNESVILLE NC 28785

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/6/2011
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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