FORM 1023-EZ for CHANGE A MOMENT CHANGE A LIFE INCORPORATED
| Field | Data |
|---|---|
| EIN | 81-0798063 |
| Case Number | EO-2018317-000507 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | CHANGE A MOMENT CHANGE A LIFE INCORPORATED |
| Organization’s Mailing Address | 8079 TARA BLVD SUITE 116 |
| City | JONESBORO |
| State | GA |
| ZIP | 30236 |
| Accounting period End | 12 |
| Primary contact name | KETURA WALKER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
KINTE ROLLINS
CFO
3707 MAIN STREET
COLLEGE PARK GA 30337
Officer/Director/Trustee Two
PATRICE JANEE WALKER
CFO
6112 DANA COURT
LITHONIA GA 30058
Officer/Director/Trustee Three
ESTHER PEEPLES
SECRETARY
3707 MAIN STREET
COLLEGE PARK GA 30337
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/10/15 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | L80 - Housing Support Services -- Other |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes 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 | Yes |
| One Third Support Gifts | No |
| Benefit of College | No |
| Private Foundation 508(e) | No |
| Seeking Retroactive Reinstatement | No |
| Seeking Section 7 Reinstatement | Yes |
| Correctness Declaration | Yes |
| Signature Name | KINTE ROLLINS |
| Signature Title | CFO |
| Signature Date | 11/11/18 |
| EIN | 81-0798063 |
| Case Number | EO-2015348-000376 |
| Form 1023-EZ version | 62014 |
| Eligibility Worksheet | 1 |
| Organization Name | CHANGE A LIFE CHANGE A MOMENT INCOPORATED |
| Organization’s Mailing Address | 8079 TARA BOULEVARD - 116 |
| City | JONESBORO |
| State | GA |
| ZIP | 30236 |
| Accounting period End | 12 |
| Primary contact name | BRANDON DRAPER |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $400.00 |
Officer/Director/Trustee One
BRANDON DRAPER
PRESIDENT
8079 TARA BOULEVARD - 116
JONESBORO GA 30236
Officer/Director/Trustee Two
KINTE ROLLINS
SECRETARY
8079 TARA BOULEVARD - 116
JONESBORO GA 30236
Officer/Director/Trustee Three
TIA JOHNSON
TREASURER
8079 TARA BOULEVARD - 116
JONESBORO GA 30236
| Organization’s website | |
|---|---|
| Organization’s email | |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 12/10/2015 |
| Organization Incorporation State | GA |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | W30 - Military, Veterans' Organizations |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes 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 | 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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