FORM 1023-EZ for RESTORY FOUNDATION

Field Data
EIN 81-5141489
Case Number EO-2017265-000160
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name RESTORY FOUNDATION
Organization’s Mailing Address 600 GRACE STREET SUITE E
City ROCKY MOUNT
State NC
ZIP 27804
Accounting period End 12
Primary contact name GOLDIE FORD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

PATRICK FORD
INITIAL DIRECTOR
3709 VICK RD
NASHVILLE NC 27856

Officer/Director/Trustee Two

THOMASENE WILSON
OFFICER
267 JESSE DRIVE
SMITHFIELD NC 27577

Officer/Director/Trustee Three

GOLDIE FORD
OFFICER
PO BOX 547
NASHVILLE NC 27856

Organization’s website
Organization’s email RESTORY4ME@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/27/2017
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 No
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
Signature Title
Signature Date

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