FORM 1023-EZ for ROOTS FARM INSTITUTE

Field Data
EIN 81-1948875
Case Number EO-2016102-000104
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROOTS FARM INSTITUTE
Organization’s Mailing Address 1001 SOUTH COUNTY LINE ROAD
City ALBANY
State GA
ZIP 31705
Accounting period End 12
Primary contact name BEVERLY BARLOW-WILLIAMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ELVIE BARLOW
PRESIDENT
165 VINTAGE TRAIL
MCDONOUGH GA 30253

Officer/Director/Trustee Two

BEVERLY BARLOW-WILLIAMS
SECRETARY
8026 FAYETTE STREET
PHILADELPHIA PA 19150

Officer/Director/Trustee Three

KAREEM SULLIVAN
TREASURER
100 DEKRUIF PLACE APT 2K
BRONX NY 10475

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/10/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A11 - Single Organization Support
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 Yes
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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