FORM 1023-EZ for MITCHELL-BAKER COUNTY MENTAL RETARDATION ASSOCIATION INC

Field Data
EIN 47-1906122
Case Number EO-2014268-000439
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MITCHELL-BAKER COUNTY MENTAL RETARDATION ASSOCIATION INC
Organization’s Mailing Address 2281 HWY 37
City CAMILLA
State GA
ZIP 31730
Accounting period End 6
Primary contact name DEANIE R CAMPBELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CARA SUMMERLIN
PRESIDENT
PO BOX 583
CAMILLA GA 31730

Officer/Director/Trustee Two

DEANIE CAMPBELL
SECRETARY/TREASURER
2281 HWY 37
CAMILLA GA 31730

Officer/Director/Trustee Three

EDDIE WILLIAMSON
BOARD MEMBER
5336 SCHLEY RD
CAMILLA GA 31730

Officer/Director/Trustee Four

BILLY TYSON
BOARD MEMBER
PO BOX 107
CAMILLA GA 31730

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/10/2013
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G20 - Birth Defects and Genetic Diseases
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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