FORM 1023-EZ for LIVING WELL YOUTH WORKS

Field Data
EIN 81-3069652
Case Number EO-2017076-000132
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name LIVING WELL YOUTH WORKS
Organization’s Mailing Address 5401 ADAMSTOWN COMMONS DRIVE
City ADAMSTOWN
State MD
ZIP 21710
Accounting period End 12
Primary contact name CLIFTON JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CLIFTON JACKSON
EXECUTIVE DIRECTOR
5401 ADAMSTOWN COMMONS DRIVE
ADAMSTOWN MD 21719

Officer/Director/Trustee Two

AYESHA JACKSON
BOARD MEMBER
5401 ADAMSTOWN COMMONS DRIVE
ADAMSTOWN MD 21710

Officer/Director/Trustee Three

VELVA COOPER
BOARD MEMBER
802 EDEN COURT
FREDERICK MD 21701

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/24/2017
Organization Incorporation State MD
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: No
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 Yes
One Third Support Gifts No
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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