FORM 1023-EZ for METROLINA NATIVE AMERICAN AFFILICATE

Field Data
EIN 85-2156373
Case Number EO-2020237-000552
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name METROLINA NATIVE AMERICAN AFFILICATE
Organization’s Mailing Address 432 HARTFORD AVE
City CHARLOTTE
State NC
ZIP 28209-1927
Accounting period End 12
Primary contact name JESSIE JACOBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JESSIE JACOBS
PRESIDENT
432 HARTFORD AVE
CHARLOTTE NC 28209-1927

Officer/Director/Trustee Two

REBECCA LACLAIRE
VICE PRESIDENT
6748 KEMP ST
CHARLOTTE NC 28213-5632

Officer/Director/Trustee Three

ANDREA RICHARDSON
SEC/TREASURY
19823 HENDERSON RD UNITN C
CORNELIUS NC 28031-5884

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/14/2020
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B11 - Single Organization Support
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 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 JESSIE JACOBS
Signature Title PRESIDENT
Signature Date 8/21/2020

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