FORM 1023-EZ for FRIENDS OF BROOKHAVEN FOUNDATION INC

Field Data
EIN 46-3753350
Case Number EO-2014297-000590
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FRIENDS OF BROOKHAVEN FOUNDATION INC
Organization’s Mailing Address 4052 SHAWNEE LANE
City BROOKHAVEN
State GA
ZIP 30319-1539
Accounting period End 8
Primary contact name BRUCE WHITMER
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHANNON CAMERON
PRESIDENT, TRUSTEE
4052 SHAWNEE LANE
BROOKHAVEN GA 30319-1539

Officer/Director/Trustee Two

J D CLOCKADALE
TRUSTEE
3198 SILVER LAKE DRIVE
BROOKHAVEN GA 30319-2394

Officer/Director/Trustee Three

BETH DIERSEN
SECRETARY, TRUSTEE
3875 THE ASCENT NE
BROOKHAVEN GA 30319-1627

Officer/Director/Trustee Four

ANNE DIPIRO
TREASURER, TRUSTEE
2608 DREW VALLEY ROAD
BROOKHAVEN GA 30319-3928

Officer/Director/Trustee Five

ELIZABETH WERDESHEIM
TRUSTEE
3720 WOODSTREAM CIRCLE
BROOKHAVEN GA 30319-2139

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/27/2013
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S20 - Community, Neighborhood Development, Improvement (General)
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
Signature Title
Signature Date

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