FORM 1023-EZ for SHEPHERD OF THE VALLEY COMMUNITY RESOURCE CENTER INC

Field Data
EIN 42-1619877
Case Number EO-2015021-000219
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name SHEPHERD OF THE VALLEY COMMUNITY RESOURCE CENTER INC
Organization’s Mailing Address 10453 ELLIMAN ROAD
City MANTUA
State OH
ZIP 44255-9483
Accounting period End 12
Primary contact name SUSAN CARLTON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

MARLENE LEFTON
MRS
14605 DORA DRIVE
NEWBURY OH 44065-9765

Officer/Director/Trustee Two

JAMES CARLTON
MR
10453 ELLIMAN ROAD
MANTUA OH 44255-9483

Officer/Director/Trustee Three

SUSAN CARLTON
DIRECTOR
10453 ELLIMAN ROAD
MANTUA OH 44255-9483

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/14/2004
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
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 Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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