FORM 1023-EZ for COMMUNITY REVIVAL INC

Field Data
EIN 82-4884303
Case Number EO-2020022-000323
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name COMMUNITY REVIVAL INC
Organization’s Mailing Address 135 HIGH STREET EXT
City LANCASTER
State MA
ZIP 01523
Accounting period End 12
Primary contact name JUSTIN ZAYAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DENNIS OUELLETTE
TREASURER & DIRECTOR
135 HIGH ST EXT
LANCASTER MA 01523

Officer/Director/Trustee Two

MOISES COSME
PRESIDENT & DIRECTOR
135 HIGH ST EXT
LANCASTER MA 01523

Officer/Director/Trustee Three

DAVID GRECO
VICE PRESIDENT & DIRECTOR
135 HIGH ST EXT
LANCASTER MA 01523

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/29/2018
Organization Incorporation State MA
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 Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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 DENNIS OUELLETTE
Signature Title TREASURER & DIRECTOR
Signature Date 1/17/2020

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