FORM 1023-EZ for AN IMAGE OF ME

Field Data
EIN 30-0291315
Case Number EO-2017268-000511
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name AN IMAGE OF ME
Organization’s Mailing Address 11503 PLANTERS ESTATES DRIVE
City CHARLOTTE
State NC
ZIP 28278-0007
Accounting period End 12
Primary contact name PENELOPE CARR-BATES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PENELOPE CARR
EXECUTIVE DIRECTOR
11503 PLANTERS ESTATES DRIVE
CHARLOTTE NC 28278

Officer/Director/Trustee Two

ROBIN STRAYHORN
PRESIDENT
7631 WOODKNOLL DRIVE
CHARLOTTE NC 28217

Officer/Director/Trustee Three

BRIDGETTE HURST
SECRETARY
15717 SOUTHERN GARDEN LANE
CHARLOTTE NC 28278

Officer/Director/Trustee Four

MONIQUE POOLE
TRESURER
7700 ELLA JANE LANE APARTMENT Q
CHARLOTTE NC 28273

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/7/2008
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O99 - Youth Development N.E.C.
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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