FORM 1023-EZ for LIFE TELEVISION NETWORK CHURCH

Field Data
EIN 82-1255407
Case Number EO-2017166-000140
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE TELEVISION NETWORK CHURCH
Organization’s Mailing Address 351 SOUTH CRAFT HIGHWAY
City CHICKASAW
State AL
ZIP 36611-2208
Accounting period End 12
Primary contact name DR HENRY W ROBERTS II
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

HENRY ROBERTS
PRESIDENT/FOUNDER
351 S CRAFT HWY
MOBILE AL 36611-2208

Officer/Director/Trustee Two

SHIRLEY SEALS
ADMINISTRATOR
351 SOUTH CRAFT HIGHWAY
CHICKASAW AL 36611-2208

Officer/Director/Trustee Three

ANTHONY AUSTIN
MANAGER
351 SOUTH CRAFT HIGHWAY
CHICKASAW AL 36611-2208

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/1/2004
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: Yes
Amateur Sports: No
Cruelty Prevention: Yes
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
Signature Title
Signature Date

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