FORM 1023-EZ for YOUTH IMPACT UNLIMITED INC

Field Data
EIN 47-3147202
Case Number EO-2015099-000533
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name YOUTH IMPACT UNLIMITED INC
Organization’s Mailing Address 100 SPRING ST
City LAGRANGE
State GA
ZIP 30240
Accounting period End 12
Primary contact name TAMIKA AVERY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

TAMIKA AVERY
PRESIDENT, DIRECTOR
100 SPRING ST
LAGRANGE GA 30240

Officer/Director/Trustee Two

MARK AVERY
SECRETARY, DIRECTOR
100 SPRING ST
LAGRANGE GA 30240

Officer/Director/Trustee Three

LATAUSHA WILLIAMS
TREASURER, DIRECTOR
100 YARMOUTH CT
LAGRANGE GA 30240

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/6/2015
Organization Incorporation State GA
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: Yes
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 Yes
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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