FORM 1023-EZ for LIFE RESTORATION OUTREACH

Field Data
EIN 80-0669275
Case Number EO-2019077-000563
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LIFE RESTORATION OUTREACH
Organization’s Mailing Address 1213 CRESCENT DR
City SMITHFIELD
State VA
ZIP 23430-1850
Accounting period End 12
Primary contact name LORENZO J MALLORY SR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LORENZO MALLORY SR
PRESIDENT
1213 CRESCENT DR
SMITHFIELD VA 23430-1850

Officer/Director/Trustee Two

TRACY MALLORY
VICE PRESIDENT
1213 CRESCENT DR
SMITHFIELD VA 23430-1850

Officer/Director/Trustee Three

KECIA BALLEN
SECRETARY
2119 ANDREWS BLVD
HAMPTON VA 23663-1101

Officer/Director/Trustee Four

SHAANA THOMAS
TREASURER
504 DAHLIA CT
NEWPORT NEWS VA 23608-1588

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/13/11
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
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 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 TRACY MALLORY
Signature Title VICE PRESIDENT
Signature Date 3/14/19

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