FORM 1023-EZ for ITAV YOUTH & FAMILY SERVICES INC

Field Data
EIN 84-1816877
Case Number EO-2019339-000356
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ITAV YOUTH & FAMILY SERVICES INC
Organization’s Mailing Address 3780 NORTHSIDE DRIVE SUITE 140-326
City MACON
State GA
ZIP 31210
Accounting period End 12
Primary contact name ANTHONY LANE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTHONY LANE
PRESIDENT
1900 WESLEYAN DR APT 2608
MACON GA 31210

Officer/Director/Trustee Two

SHALONDIE STEPHEN
VICE PRESIDENT
1129 BRIARCLIFF ROAD
MACON GA 31211

Officer/Director/Trustee Three

ADRIAN HOWARD
SECRETARY
2480 SHEA DRIVE
MACON GA 31206

Officer/Director/Trustee Four

CYNTHIA BANKS
TREASURER
139 COUNTRY OAKS DR
MACON GA 31220

Officer/Director/Trustee Five

WILLE DUMAS
ALTERNATE
349 CHRISTINA COURT
MACON GA 31217

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/25/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: No
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 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 ANTHONY LANE
Signature Title PRESIDENT
Signature Date 12/3/2019

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