FORM 1023-EZ for LEWIS REFERRAL AGENCY CORP

Field Data
EIN 86-2669461
Case Number EO-2021098-000020
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name LEWIS REFERRAL AGENCY CORP
Organization’s Mailing Address 4207 ST AUGUSTINE RD
City MONTICELLO
State FL
ZIP 32344
Accounting period End 12
Primary contact name YOLANDA LEWIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SILAS LEWIS
PRESIDENT
4395 COOLVIEW DR
TALLAHASSEE FL 32303

Officer/Director/Trustee Two

ELDER CARRIE HOLTON
VICE PRESIDENT
722 DENT STREET
TALLAHASSEE FL 32304

Officer/Director/Trustee Three

REV PETER LAWSON
DIRECTOR
291 ROSALIE DRIVE
NEW BRAUNREL TX 78130

Officer/Director/Trustee Four

RENALDA BRINSON
DIRECTOR
1530 LIVE OAK DR
TALLAHASSEE FL 32301

Officer/Director/Trustee Five

YOLANDA LEWIS
CEO
4207 ST AUGISTINE RD
MONTICELLO FL 32344

Organization’s website
Organization’s email YLEWIS805@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/8/2018
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P50 - Personal Social Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 Yes
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 YOLANDA LEWIS
Signature Title CEO
Signature Date 3/17/2021

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