FORM 1023-EZ for PURE ENTERTAINMENT ZONE FOR TEENS INCORPORATED

Field Data
EIN 83-1398000
Case Number EO-2018337-000154
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PURE ENTERTAINMENT ZONE FOR TEENS INCORPORATED
Organization’s Mailing Address 416 CLARENDON CT APT B
City ALBANY
State GA
ZIP 31707
Accounting period End 12
Primary contact name LATOYA N GRACE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

LERKEESHA JACKSON
CEO
416 CLARENDON CT APT B
ALBANY GA 31707

Officer/Director/Trustee Two

CICELY GRANT
SECRETARY
3414 SWEET BRIER RD
ALBANY GA 31701

Officer/Director/Trustee Three

STACY MERRITT
PRESIDENT
108 GAMAN COURT
LEESBURG GA 31763

Officer/Director/Trustee Four

RODERICK GREEN
VICE PRESIDENT
634 CALLIS RD
DAWSON GA 39842

Officer/Director/Trustee Five

LINDA BLOCKER
FINANCIAL OFFICER
711 S MADISON STREET
ALBANY GA 31701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/24/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
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 LERKEESHA JACKSON
Signature Title CEO
Signature Date 11/29/18

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