FORM 1023-EZ for MEMORY LANE

Field Data
EIN 82-0865467
Case Number EO-2017083-000058
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MEMORY LANE
Organization’s Mailing Address 621 E 45TH PLACE N
City TULSA
State OK
ZIP 74106
Accounting period End 12
Primary contact name DARINA WILSON-MCCLELLAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARINA WILSON-MCCLELLAN
PRESIDENT
635 E 45TH PLACE N
TULSA OK 74106

Officer/Director/Trustee Two

KEENAN MCCLELLAN
VICE-PRESIDENT
635 E 45TH PLACE N
TULSA OK 74106

Officer/Director/Trustee Three

KOWANA SHIELDS
SECRETARY
621 E 4TH PLACE N
TULSA OK 74106

Officer/Director/Trustee Four

DIAHANNE MCCLELLAN
TREASURER
1366 E 54TH STREET N
TULSA OK 74106

Organization’s website
Organization’s email
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/1/2017
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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
Signature Title
Signature Date

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