FORM 1023-EZ for CITI LYFE FOUNDATION

Field Data
EIN 81-4319418
Case Number EO-2019116-000389
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CITI LYFE FOUNDATION
Organization’s Mailing Address 2625 NW 55TH ST
City MIAMI
State FL
ZIP 33142
Accounting period End 12
Primary contact name TAIWAN JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TODD JOHNSON
PRESIDENT
2625 NW 55TH ST
MIAMI FL 33142

Officer/Director/Trustee Two

TAIWAN JACKSON
VICE PRESIDENT
2625 NW 122 ST
MIAMI FL 33167

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/25/16
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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 TAIWAN JACKSON
Signature Title VICE PRESIDENT
Signature Date 4/24/19

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