FORM 1023-EZ for VICTORY OUTREACH

Field Data
EIN 58-2393626
Case Number EO-2015134-000194
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name VICTORY OUTREACH
Organization’s Mailing Address 1170 N HAIRSTON RD
City STONE MOUNTAIN
State GA
ZIP 30083
Accounting period End 12
Primary contact name DR KENNETH SAMUEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LEONARD WRIGHT
BOARD MEMBER
2444 FORREST PARK RD SE
ATLANTA GA 30354

Officer/Director/Trustee Two

KENNETH SAMUEL
BOARD MEMEBR
1170 N HAIRSTON RD
STONE MOUNTAIN GA 30083

Officer/Director/Trustee Three

PHYLLIS WILLIAMS
BOARD MEMBER
4126 MOUNTAIN OAK COVE
STONE MOUNTAIN GA 30083

Officer/Director/Trustee Four

JARMAR EVANS
BOARD MEMBER
1018 BELMONT COMMONS DR
SMYRNA GA 30080

Officer/Director/Trustee Five

SHARRON JAMESON
BOARD MEMBER
1039 SHADY SPRING CT
LAWRENCEVILLE GA 30045

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/11/1998
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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