FORM 1023-EZ for CHRIST HOUSE INTERNATIONAL INC

Field Data
EIN 82-2421797
Case Number EO-2017283-000427
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHRIST HOUSE INTERNATIONAL INC
Organization’s Mailing Address 4231 TRUMAN DR
City SEFFNER
State FL
ZIP 33584
Accounting period End 12
Primary contact name STEVE MARSHALL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAMILLIA JEFFERIES
PRESIDENT
8165 CANTERBURY LAKES BLVD
TAMPA FL 33619

Officer/Director/Trustee Two

STEVE MARSHALL
CHIEF EXECUTIVE OFFICER
14623 WALNUT BEND WAY APT 204
LUTZ FL 33549

Officer/Director/Trustee Three

DANIEL POWELL SR
DIRECTOR
11444 VILLAGE BROOK DR
RIVERVIEW FL 33579

Officer/Director/Trustee Four

LISSA DILLARD
TREASURER
337 E DARTMOUTH ST
FLINT MI 48505

Officer/Director/Trustee Five

JANICE WRIGHT
SECRETARY
4124 SIMMS ROAD
LAKELAND FL 33810

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/7/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 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
Signature Title
Signature Date

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