FORM 1023-EZ for 53017N INC

Field Data
EIN 82-2733312
Case Number EO-2017254-000438
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name 53017N INC
Organization’s Mailing Address 3355 LENOX RD SUITE 750
City ATLANTA
State GA
ZIP 30326-1353
Accounting period End 12
Primary contact name TERRY POWELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERRY POWELL
CHIEF FINANCIAL OFFICER
689 VININGS ESTATES DR
MABLETON GA 30126-5934

Officer/Director/Trustee Two

DIANNA CLARKSON
CHIEF EXECUTIVE OFFICER
3418 BRETON CT
ATLANTA GA 30319-2408

Officer/Director/Trustee Three

EARL SIMS
CHIEF OPERATING OFFICER
4956 WARMSTONE WAY
ATLANTA GA 30339-1699

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/20/2017
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A12 - Fund Raising and/or Fund Distribution
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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