FORM 1023-EZ for CENTRE LYME INC

Field Data
EIN 82-1345683
Case Number EO-2018155-000181
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CENTRE LYME INC
Organization’s Mailing Address 1215 DEERFIELD DRIVE
City STATE COLLEGE
State PA
ZIP 16803
Accounting period End 12
Primary contact name JONATHAN DIETZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JONATHAN DIETZ
PRESIDENT
1215 DEERFIELD RIVE
STATE COLLEGE PA 16803

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/17
Organization Incorporation State PA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G80 - Specifically Named Diseases
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 Yes
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 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 JONATHAN DIETZ
Signature Title PRESIDENT
Signature Date 5/31/18

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