FORM 1023-EZ for FAITH BELIEVERS THAT CHANGE LIVES

Field Data
EIN 87-1407885
Case Number EO-2021193-000793
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAITH BELIEVERS THAT CHANGE LIVES
Organization’s Mailing Address 4828 REGIMENT COURT
City WOODBRIDGE
State VA
ZIP 22193
Accounting period End 1
Primary contact name TRACEY WILKINS CLARK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TRACEY WILKINS CLARK
CEO
4828 REGIMENT COURT
WOODBRIDGE VA 22193

Organization’s website
Organization’s email FBCLNONPROFIT@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/7/2021
Organization Incorporation State VA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K31 - Food Banks, Food Pantries
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 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 TRACEY WILKINS CLARK
Signature Title CEO
Signature Date 7/8/2021

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