FORM 1023-EZ for BROKEN CRAYONS RESTORATION LIFE CENTER INC

Field Data
EIN 82-2974445
Case Number EO-2017283-000388
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BROKEN CRAYONS RESTORATION LIFE CENTER INC
Organization’s Mailing Address 333 HEATHER ST FAIRFIELD TX 75840
City FAIRFIELD
State TX
ZIP 75840-2327
Accounting period End 12
Primary contact name PAMELA BARNES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PAMELA BARNES
PRESIDENT
333 HEATHER ST
FAIRFIELD TX 75840-2327

Officer/Director/Trustee Two

SONOMA ADKINS
SECRETARY
151 CR 601
FAIRFIELD TX 75840-4015

Officer/Director/Trustee Three

JEANNIE KEENEY
TREASURER
333 HEATHER ST
FAIRFIELD TX 75840-2327

Officer/Director/Trustee Four

DEXTER BARNES
1ST VICE PRESIDENT
333 HEATHER ST
FAIRFIELD TX 75840-2327

Officer/Director/Trustee Five

DORIS MCWILLIAMS-BREWER
2ND VICE PRESIDENT
1503 MULBERRY ST
TEAGUE TX 75840-2362

Organization’s website
Organization’s email BROKENCRAYONSRLC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/6/2017
Organization Incorporation State TX
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P19 - Nonmonetary Support N.E.C.
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 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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