FORM 1023-EZ for EMPOWER MENTOR PREPARE ADVOCATE FORCOACH TEACH INC

Field Data
EIN 81-2657783
Case Number EO-2016141-000345
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EMPOWER MENTOR PREPARE ADVOCATE FORCOACH TEACH INC
Organization’s Mailing Address 441 FOREST ROAD
City MILLEDGEVILLE
State GA
ZIP 31061
Accounting period End 12
Primary contact name J LANCE STRIBLING
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

RECHARD LARKIN
CHAIRMAN DIRECTOR
441 FOREST ROAD
MILLEDGEVILLE GA 31061

Officer/Director/Trustee Two

KAREN LARKIN
VICE CHAIRMAN DIRECTOR
441 FOREST ROAD
MILLEDGEVILLE GA 31061

Officer/Director/Trustee Three

LAVONNE SMITH
SECRETARY DIRECTOR
112 OLD MILL COURT
MILLEDGEVILLE GA 31061

Officer/Director/Trustee Four

DEVALON VERNICE HILL
SECRETARY DIRECTOR
110 HARDWOOD DRIVE SW
MILLEDGEVILLE GA 31061

Officer/Director/Trustee Five

NEHEMIAH INGRAM
DIRECTOR
2423 VERNDALE DRIVE
MILLEDGEVILLE GA 31061

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/12/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O01 - Alliance/Advocacy Organizations
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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