FORM 1023-EZ for FAMILY ADVOCACY MEDIATION INTERVENTION SERVICES

Field Data
EIN 82-0838473
Case Number EO-2017223-000065
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAMILY ADVOCACY MEDIATION INTERVENTION SERVICES
Organization’s Mailing Address PO BOX 306
City LADSON
State SC
ZIP 29456
Accounting period End 12
Primary contact name TRAVIS SHAFFER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRAVIS SHAFFER
PRESIDENT
502 PLEASANT SIDE DR
MONCKS CORNER SC 29461

Officer/Director/Trustee Two

JADA SHAFFER
VICE PRESIDENT
1222 FELDER AVENUE
MONTGOMERY AL 36106

Officer/Director/Trustee Three

BARBARA BERGER
SECRETARY
205 PELICAN LANE
LADSON SC 29456

Officer/Director/Trustee Four

RUKAIYAH WILLIAMS
TREASURER
4370 LADSON RD
LADSON SC 29456

Organization’s website
Organization’s email FAMISERVICES@HOMESC.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/12/2016
Organization Incorporation State SC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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