FORM 1023-EZ for BLACK LIVES MATTER LAKE COUNTY

Field Data
EIN 85-2708936
Case Number EO-2020281-000136
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LIVES MATTER LAKE COUNTY
Organization’s Mailing Address PO BOX 412
City MENTOR
State OH
ZIP 44061-0412
Accounting period End 12
Primary contact name LINDA JULIAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARSITA FERGUSON
PRESIDENT
66 STOCKWELL STREET
PAINESVILLE OH 44077-3628

Officer/Director/Trustee Two

INDY-ASYA BANKSTON
TREASURER
1505 ARBOR STREET UNIT 7
WICKLIFFE OH 44092-1553

Officer/Director/Trustee Three

CHARLIE KIMBROUGH
SECRETARY
1919 WESTMONT LANE APT 706
MENTOR OH 45205-1140

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/2/2020
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R22 - Minority Rights
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence Yes
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARSITA FERGUSON
Signature Title PRESIDENT
Signature Date 10/3/2020

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