FORM 1023-EZ for CREATE APPALACHIA

Field Data
EIN 47-1863604
Case Number EO-2014265-000188
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CREATE APPALACHIA
Organization’s Mailing Address 1304 BUFFALO ST
City JOHNSON CITY
State TN
ZIP 37604
Accounting period End 6
Primary contact name CHERYL CORNETT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHERYL CORNETT
CHEIF EXECUTIVE OFFICER
1304 BUFFALO ST
JOHNSON CITY TN 37604

Officer/Director/Trustee Two

DEBORAH HARLEY MCCLASKY
CHAIR
6 GARDEN WAY
JONESBOROUGH TN 37659

Officer/Director/Trustee Three

KATE CRAIG
TREASURER
1200 S COURTHOUSE DR APT 632
ARLINGTON VA 22204

Officer/Director/Trustee Four

JOSHUA SHEPHERD
SECRETARY
PO BOX 12459
JOHNSON CITY TN 37614

Officer/Director/Trustee Five

KENNY CORNETT
BOARD MEMBER
38 MAPLE RIDGE CT
JONESBOROGH TN 37659

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/16/2014
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code W99 - Public, Society Benefit - Multipurpose and Other N.E.C.
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
Scientific: No
Literary: Yes
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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