FORM 1023-EZ for MINDSET 4 CHANGE

Field Data
EIN 82-1282018
Case Number EO-2017122-000147
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MINDSET 4 CHANGE
Organization’s Mailing Address 904 REVEILLE RD
City FORT WORTH
State TX
ZIP 76108
Accounting period End 12
Primary contact name TANIA LEWIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TANIA LEWIS
PRESIDENT, DIRECTOR
904 REVEILLE RD
FORT WORTH TX 76108

Officer/Director/Trustee Two

CHAQUITA GIBSON
SECRETARY, DIRECTOR
5637 PALADIUM DR
DALLAS TX 75249

Officer/Director/Trustee Three

DENISE GONDER
TREASURER, DIRECTOR
6865 CHICKERING RD APT 418
FORT WORTH TX 76116

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/21/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
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 Yes
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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