FORM 1023-EZ for LIFTED RENAISSANCE INC

Field Data
EIN 47-4992375
Case Number EO-2015281-000258
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIFTED RENAISSANCE INC
Organization’s Mailing Address 579 PELHAM PLACE
City MCDONOUGH
State GA
ZIP 30253
Accounting period End 12
Primary contact name CARLTON ROSS JR
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CARLTON ROSS JR
CEO/BOARD MEMBER
579 PELHAM PLACE
MCDONOUGH GA 30253

Officer/Director/Trustee Two

JAVAN BASS
BOARD MEMBER
361 17TH STREET NW
ATLANTA GA 30363

Officer/Director/Trustee Three

ALEXES GREEN
BOARD MEMBER
407 THOMAS DOWNS WAY
JONESBORO GA 30238

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/19/2015
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: Yes
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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