FORM 1023-EZ for REVIVAL

Field Data
EIN 84-3063882
Case Number EO-2020119-000073
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name REVIVAL
Organization’s Mailing Address 53 46TH ST NE
City WASHINGTON
State DC
ZIP 20019
Accounting period End 9
Primary contact name KARLETON THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KARLETON THOMAS
PRESIDENT/CEO
53 46TH ST NE
WASHINGTON DC 20019

Officer/Director/Trustee Two

DENISE THOMAS
BOARD CHAIRMAN
1406 ROLLINGHOUSE DRIVE
FREDERICK MD 21703

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/22/2019
Organization Incorporation State DC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S31 - Urban, Community Economic Development
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 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 KARLETON THOMAS
Signature Title PRESIDENT/CEO
Signature Date 4/26/2020

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