FORM 1023-EZ for UKOMBOZI

Field Data
EIN 84-1773074
Case Number EO-2019144-000236
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name UKOMBOZI
Organization’s Mailing Address 204 TANYA STREET
City LAFAYETTE
State LA
ZIP 70507
Accounting period End 12
Primary contact name MICAH VIDRINE CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EMILY THIBODEAUX
PRESIDENT
204 TANYA STREET
LAFAYETTE LA 70507

Officer/Director/Trustee Two

RICKY THIBODEAUX
VICE-PRESIDENT
204 TANYA STREET
LAFAYETTE LA 70507

Officer/Director/Trustee Three

STEPHANIE DOMENGEAUX
TREASURER
39095 SAND HILL ROAD
WALKER LA 70785

Officer/Director/Trustee Four

PAUL BURKE
DIRECTOR
111 ARUBA DRIVE
LAFAYETTE LA 70507

Officer/Director/Trustee Five

CURVINE BREWINGTON
DIRECTOR
106 BROLAND
DUSON LA 70529

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/19
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 EMILY THIBODEAUX
Signature Title PRESIDENT
Signature Date 5/22/19

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