FORM 1023-EZ for AUTISM LIFE CENTER INC

Field Data
EIN 83-2037242
Case Number EO-2019030-000788
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AUTISM LIFE CENTER INC
Organization’s Mailing Address 5462 RIVER RIDGE ST
City ELIDA
State OH
ZIP 45807
Accounting period End 12
Primary contact name TERA VIOLA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TERA VIOLA
CEO
5462 RIVER RIDGE ST
ELIDA OH 45807

Officer/Director/Trustee Two

ANITA RIEMAN
PRESIDENT
12005 ROAD 9K
OTTAWA OH 45875

Officer/Director/Trustee Three

CORRINE CORBETT
SECRETARY
11813 HOLLYWOOD PL
WAPAKONETA OH 45895

Officer/Director/Trustee Four

MONICA DULEBOHN
TREASURER
312 BAXTER ST
ELIDA OH 45807

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/4/18
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G84 - Autism
Organization’s purpose Charitable: Yes
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 Yes
Donation of funds Yes
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 TERA VIOLA
Signature Title CEO
Signature Date 12/27/18

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