FORM 1023-EZ for KLEAN PLATE COMMUNITY OUTREACH

Field Data
EIN 82-3177262
Case Number EO-2018137-000508
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KLEAN PLATE COMMUNITY OUTREACH
Organization’s Mailing Address 4002 LAWRENCEVILLE HIGHWAY
City TUCKER
State GA
ZIP 30084
Accounting period End 7
Primary contact name KATRICE SIMMONS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KATRICE SIMMONS
PRESIDENT
783 CARTER RD
JONESBORO GA 31015

Officer/Director/Trustee Two

CARLOS BRINSON
VICE PRESIDENT
812 22ND AVE W
CORDELE GA 31015

Officer/Director/Trustee Three

KACY SIMON
TREASURER
1375 COLLEGE STATION RD APT 102
ATHENS GA 30605

Officer/Director/Trustee Four

CARLANDER SHUMPERT
SECRETARY
2213 GENNINGS COURT
COLUMBUS GA 31906

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/1/17
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A01 - 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 KATRICE SIMMONS
Signature Title PRESIDENT
Signature Date 5/4/18

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