FORM 1023-EZ for CHEVERLY VILLAGE INC

Field Data
EIN 81-2226810
Case Number EO-2016109-000179
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHEVERLY VILLAGE INC
Organization’s Mailing Address 3416 BELLEVIEW AVENUE
City CHEVERLY
State MD
ZIP 20785-1230
Accounting period End 12
Primary contact name DIANE E LA VOY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DIANE LA VOY
BOD PRESIDENT
3416 BELLEVIEW AVENUE
CHEVERLY MD 20785-1230

Officer/Director/Trustee Two

LAILA RIAZI
BOD VICE PRESIDENT
3406 BELLEVIEW AVENUE
CHEVERLY MD 20785-1230

Officer/Director/Trustee Three

DAVID WATKINS
BOD TREASURER
5801 DEWEY STREET
CHEVERLY MD 20785-2937

Officer/Director/Trustee Four

LARRY BEYNA
BOD SECRETARY
6014 HAWTHORNE STREET
CHEVERLY MD 20785-3139

Officer/Director/Trustee Five

KIMBERLY LOWERY WALKER
BOD MEMBER
3106 LAKE AVENUE
CHEVERLY MD 20785-1221

Organization’s website WWW.CHEVERLYVILLAGE.ORG
Organization’s email CHEVVILLAGE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/13/2016
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P81 - Senior Centers, 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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