FORM 1023-EZ for CHANGING LIVES AND CHANGING PATTERNS INC

Field Data
EIN 47-5570061
Case Number EO-2015353-000120
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CHANGING LIVES AND CHANGING PATTERNS INC
Organization’s Mailing Address 1934 WEST 5TH AVENUE SUITE 103
City GARY
State IN
ZIP 46404
Accounting period End 12
Primary contact name BELINDA WHITFIELD
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BURGESS PEOPLES
PRESIDENT
1934 WEST 5TH AVENUE
GARY IN 46404

Officer/Director/Trustee Two

SONYA WALKER
SECRETARY
1007 FIELDSIDE DRIVE
MATTESON IL 60443

Officer/Director/Trustee Three

GLENDA JEMISON
TREASURER
6747 NEW JERSEY AVENUE
HAMMOND IN 46323

Officer/Director/Trustee Four

KEITH NELSON
DIRECTOR
630 CREEKSIDE DRIVE
LOWELL IN 46356

Officer/Director/Trustee Five

ERIC RIDEOUT
DIRECTOR
5940 SUNDANCE TRAIL
PORTAGE IN 46368

Organization’s website WWW.CHANGINGLIVESCHANGINGPATTERNS.ORG
Organization’s email BURGESS.PEOPLES@CHANGINGLIVESCHANGINGPATTERNS.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/7/2015
Organization Incorporation State IN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O20 - Youth Centers, Clubs, Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 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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