FORM 1023-EZ for URBAN COMMUNITY LIFE INC

Field Data
EIN 46-0763513
Case Number EO-2016334-000125
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name URBAN COMMUNITY LIFE INC
Organization’s Mailing Address 279 CHALKLEY RD
City TEMPLE
State GA
ZIP 30179
Accounting period End 12
Primary contact name RUSTIN SWEENEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RUSTIN SWEENEY
EXECUTIVE DIRECTOR
279 CHALKLEY RD
TEMPLE GA 30179

Officer/Director/Trustee Two

DAVID SHERWOOD
CHAIRMAN
120 ARIEL COURT
ROSWELL GA 30075

Officer/Director/Trustee Three

DANIEL SHOKAI
SECRETARY
581 MIMOSA DR
TUCKER GA 30084

Officer/Director/Trustee Four

ALYSSA WALDRON
TREASURER
4064 BEARDEN LN
DOUGLASVILLE GA 30135

Officer/Director/Trustee Five

BRIGHTON SWEENEY
BOARD MEMBER
279 CHALKLEY RD
TEMPLE GA 30179

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/26/2012
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S99 - Community Improvement, Capacity Building N.E.C.
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 Yes
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 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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