FORM 1023-EZ for BLACK LIVES MATTER CHANGE FOR US

Field Data
EIN 86-2452783
Case Number EO-2021126-000367
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK LIVES MATTER CHANGE FOR US
Organization’s Mailing Address 13535 SILVERSAND STREET
City VICTORVILLE
State CA
ZIP 92394
Accounting period End 12
Primary contact name DARLENE SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DARLENE SMITH
CEO
13535 SILVERSAND STREET
VICTORVILLE CA 92394

Officer/Director/Trustee Two

LUCRETIA SMITH
SECRETARY
13535 SILVERSAND STREET
VICTORVILLE CA 92394

Officer/Director/Trustee Three

BRANDON SMITH
CFO
13535 SILVERSAND STREET
VICTORVILLE CA 92394

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/6/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R20 - Civil Rights, Advocacy for Specific Groups
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 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 DARLENE SMITH
Signature Title CEO
Signature Date 5/4/2021

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