FORM 1023-EZ for LUCKYS CAT HOUSE

Field Data
EIN 84-4555271
Case Number EO-2020057-000243
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LUCKYS CAT HOUSE
Organization’s Mailing Address 5130 DE LINA ROAD
City CORNERSVILLE
State TN
ZIP 37047
Accounting period End 12
Primary contact name CYNTHIA BURTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CYNTHIA BURTON
PRESIDENT
5130 DE LINA ROAD
CORNERSVILLE TN 37047-5328

Officer/Director/Trustee Two

JACLYN PAYNE
DIRECTOR OF OPERATIONS
1080 BOONES HILL ROAD
PETERSBURG TN 37144-2308

Officer/Director/Trustee Three

PHILIP RANDALL
ADMINISTRATIVE DIRECTOR
3884 HEARTHSTONE DRIVE
CHAPEL HILL TN 37034-2082

Officer/Director/Trustee Four

LAURA ROWLAND
VETERINARY LIASON
2757 SPRING PLACE ROAD
BELFAST TN 37019-2042

Officer/Director/Trustee Five

KARON JOHNSON
FOSTER AND VOLUNTEER COORDINATOR
1360 OLD FARMINGTON ROAD
LEWISBURG TN 37091-2212

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/16/2020
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: No
Religious: No
Educational: No
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name CYNTHIA BURTON
Signature Title PRESIDENT
Signature Date 2/24/2020

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