FORM 1023-EZ for CULTURE LIFE SUPPORTIVE SERVICES

Field Data
EIN 85-0999629
Case Number EO-2020135-000197
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CULTURE LIFE SUPPORTIVE SERVICES
Organization’s Mailing Address 1317 ST MATTHEWS DR
City MIDWEST CITY
State OK
ZIP 73110
Accounting period End 12
Primary contact name JOHNNY MIXON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOHNNY MIXON
PRESIDENT
1317 ST MATTHEWS DR
MIDWEST CITY OK 73110

Officer/Director/Trustee Two

MYLES NEWTON
TREASURER
14600 NORTH ROCKWELL APT 717
OKLAHOMA CITY OK 73142

Officer/Director/Trustee Three

JERDAVION KNOX
DIRECTOR
2438 NW 12TH
OKLAHOMA OK 73107

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/12/2020
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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 Yes
Gaming Activity No
Disaster relief assistance Yes
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 JOHNNY MIXON
Signature Title PRESIDENT
Signature Date 5/12/2020

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