FORM 1023-EZ for CHOICES FOR LIFE INC

Field Data
EIN 26-0253959
Case Number EO-2016314-000256
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHOICES FOR LIFE INC
Organization’s Mailing Address 1325 E RITTER ST
City REPUBLIC
State MO
ZIP 65738
Accounting period End 12
Primary contact name MARILYN ERNEST
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARILYN ERNEST
PRESIDENT
19240 LAWRENCE 2227
AURORA MO 65605

Officer/Director/Trustee Two

JASON ERNEST
DIRECTOR
552 W PEARL ST
AURORA MO 65605

Officer/Director/Trustee Three

JEROMY HOUCHIN
DIRECTOR
1325 E RITTER ST
REPUBLIC MO 65738

Officer/Director/Trustee Four

JANET SELADIS
DIRECTOR
306 ROMAINE SPRING VIEW
FENTON MO 63026

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/2007
Organization Incorporation State MO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X12 - Fund Raising and/or Fund Distribution
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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