FORM 1023-EZ for CAPITAL REBIRTH INC

Field Data
EIN 83-4414382
Case Number EO-2019212-000295
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CAPITAL REBIRTH INC
Organization’s Mailing Address 2247 N 3RD STREET
City HARRISBURG
State PA
ZIP 17110
Accounting period End 12
Primary contact name MIKELL SIMPSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MIKELL SIMPSON
CEO
2247 N 3RD STREET
HARRISBURG PA 17110

Officer/Director/Trustee Two

MAURICE COVINGTON
BOARD PRESIDENT
450 AFTON POND CT APT 322
CHARLOTTESVILLE VA 22902

Officer/Director/Trustee Three

WILLIAM ROYAL
BOARD SECRETARY
610 HUMPHREY CT APT 201
HARRISBURG PA 17109

Officer/Director/Trustee Four

DENZEL BURRELL
BOARD TREASURER
1225 S PARKCREST CT
GILBERT AZ 85296

Organization’s website CAPITALREBIRTH.COM
Organization’s email CAPITALREBIRTH717@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/2/19
Organization Incorporation State PA
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: 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 No
One Third Support Gifts No
Benefit of College Yes
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MIKELL SIMPSON
Signature Title CEO
Signature Date 7/29/19

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