FORM 1023-EZ for ORIGINAL DESIGN

Field Data
EIN 86-2391812
Case Number EO-2021099-002011
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ORIGINAL DESIGN
Organization’s Mailing Address 1720 ENOREE AVENUE
City COLUMBIA
State SC
ZIP 29205
Accounting period End 12
Primary contact name JAY URICH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JAY URICH
PRESIDENT
1720 ENOREE AVENUE
COLUMBIA SC 29205

Officer/Director/Trustee Two

MARCUS LATTIMORE
SECRETARY
735 SW ST CLAIRE AVENUE APT 605
PORTLAND OR 97205

Officer/Director/Trustee Three

CONNOR SHAW
TREASURER
15 CREEK MANOR LANE
COLUMBIA SC 29206

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2021
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N20 - Recreational and Sporting Camps
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 Yes
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 No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JAY URICH
Signature Title PRESIDENT
Signature Date 3/23/2021

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