FORM 1023-EZ for SURVIVOR PRIDE

Field Data
EIN 82-1061649
Case Number EO-2017109-000136
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SURVIVOR PRIDE
Organization’s Mailing Address 215 MICKEY RD
City LAFAYETTE
State LA
ZIP 70507
Accounting period End 12
Primary contact name DEBREKA HANDY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DEBREKA HANDY
EXECUTIVE DIRECTOR
215 MICKEY RD
LAFAYETTE LA 70507

Officer/Director/Trustee Two

IRIS WOODS
TREASURER
236 DURIO STREET
SUNSET LA 70584

Officer/Director/Trustee Three

TYTIANNA JACOBS
MEMBER
100 FONTAINE DR
LAFAYETTE LA 70506

Officer/Director/Trustee Four

TASHA ANGELLE
SECRETARY
117 ST FABIAN DR
CARENCRO LA 70520

Organization’s website JDEBRICA32@YAHOO.COM
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2017
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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
Signature Title
Signature Date

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