FORM 1023-EZ for KINGSHIP MENTOR SERVICES

Field Data
EIN 83-2948304
Case Number EO-2019031-000192
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KINGSHIP MENTOR SERVICES
Organization’s Mailing Address 333 NE RUSSELL ST APT 211
City PORTLAND
State OR
ZIP 97212
Accounting period End 12
Primary contact name WILLIE THOMAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

WILLIE THOMAS
PRESIDENT
1650 NE KILLINGSOWTH ST APT 206
PORTLAND OR 97211

Officer/Director/Trustee Two

TONIA STAPLES
SECRETARY
11444 SE 90TH AVE APT 1311
HAPPY OR 97211

Officer/Director/Trustee Three

CHARMAINE REDDIX
TREASURE
2132 SE 162ND AVE
PORTLAND OR 97233

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/21/18
Organization Incorporation State OR
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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 WILLIE THOMAS
Signature Title PRESIDENT
Signature Date 1/2/19

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