FORM 1023-EZ for LIFE 101

Field Data
EIN 46-2195003
Case Number EO-2014220-000116
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFE 101
Organization’s Mailing Address PO BOX 453
City CAMP SHERMAN
State OR
ZIP 97730-9622
Accounting period End 12
Primary contact name LAURIE ADAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

LAURIE ADAMS
PRESIDENT
PO BOX 668
CAMP SHERMAN OR 97730-9622

Officer/Director/Trustee Two

KEVIN ADAMS
SECRETARY
PO BOX 668
CAMP SHERMAN OR 97730-9622

Organization’s website WWW.LIFEONYOUROWN.ORG
Organization’s email LIFE101.LIFEONYOUROWN@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/22/2013
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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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